Showing papers by "Roberto Romero published in 1992"
TL;DR: Results support the hypothesis that premature birth results in part from infection caused by genital tract bacteria, and research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.
887 citations
TL;DR: Amniocentesis to determine the microbiologic characteristics of the amniotic cavity should be considered before a cerclage is placed in women presenting with cervical dilatation in the midtrimester of pregnancy.
572 citations
TL;DR: Parturition in the setting of microbial invasion of the amniotic cavity is associated with activation of the cytokine network as demonstrated by the detection of tumor necrosis factor in human amniotics fluid.
366 citations
TL;DR: The results suggest that interleukin-1-induced preterm delivery in mice is mediated by the interleucin-2 receptor, which is implicated in the mechanisms responsible for preterm parturition in the setting of intrauterine infection.
212 citations
TL;DR: The presence of acute inflammatory lesions of the chorioamniotic membranes can serve as a marker of microbial invasion of the amniotic cavity.
210 citations
TL;DR: Data indicate that microbial invasion of the amniotic cavity occurs in approximately one third of patients with preterm premature rupture of membranes, which is a risk factor for endometritis in women with term premature rupturing of membranes.
132 citations
TL;DR: Amniotic fluid contains the highest interleukin-1 receptor antagonist concentrations detected in any biologic fluid to date and exogenous anticytokine agents may be of value in the treatment of preterm labor.
131 citations
01 Jan 1992
TL;DR: Whether measurement of amniotic fluid concentrations of interleukin 6 could be of value in the diagnosis of microbial invasion of theAmniotic cavity was established and patients with an amniotics fluid interleucin 6 level above 11.2 ng/ml were at risk for congenital infections.
Abstract: A growing body of evidence suggests a role for cytokines in the mechanisms responsible for preterm parturition associated with intrauterine infection. Interleukin 6, a polyfunctional cytokine that is secreted by tissues in the feto-maternal interface in response to microbial products, has been implicated in the host response to intrauterine infection. The purpose of this study was to establish whether measurement of amniotic fluid concentrations of interleukin 6 could be of value in the diagnosis of microbial invasion of the amniotic cavity. Fluid was obtained by transabdominal amniocentesis from patients with preterm labour and intact chorioamniotic membranes and cultured for aerobic and anaerobic bacteria and mycoplasmas. Interleukin 6 concentrations were determined by an ELISA validated for human amniotic fluid. An interleukin 6 concentration above 11.2 ng/ml had a 93.7% sensitivity and a 92.3% specificity in the diagnosis of intra-amniotic infection. Moreover, patients with an amniotic fluid interleukin 6 level above 11.2 ng/ml and a negative amniotic fluid culture failed to respond to tocolysis, delivered a preterm infant and showed histological evidence of chorioamnionitis, and their neonates were at risk for congenital infections.
90 citations
TL;DR: Antibiotic treatment was associated with eradication of Ureaplasma urealyticum from the amniotic cavity, pregnancy prolongation, and neonatal survival.
48 citations
45 citations
TL;DR: A role for endothelins in the mechanisms responsible for preterm delivery associated with intraamniotic infection is supported, and women with preterm labor and positive amniotic fluid cultures for microorganisms had higher amniotics fluid concentrations of endothelin-1,2.
TL;DR: Analysis of the data reveals that fetal lung maturation is biochemically comparable between twin and singleton pregnancies and among twins for a given gestational age in this clinical setting.
Abstract: Preterm labor or premature rupture of membranes is one of the major complications of twin pregnancies and contributes to the increased maternal and perinatal morbidity and mortality. Forty-seven twin pregnancies and a comparable group of singleton pregnancies constitute the study population. These patients' pregnancies were complicated only by preterm labor. The lecithin to sphingomyelin ratio is used as an index of fetal lung maturation. Analysis of the data reveals that fetal lung maturation is biochemically comparable between twin and singleton pregnancies and among twins for a given gestational age in this clinical setting.
TL;DR: The prenatal diagnosis of hiatal hernia with ultrasonography is described and described, using high-resolution sonography of the fetus for the recognition of an increasing number of congenital anomalies.
Abstract: High-resolution sonography of the fetus allows a detailed examination of fetal anatomy and the recognition of an increasing number of congenital anomalies. Several anatomic anomalies involving the fetal thoracic cavity have been described, including pleural effusion, lung sequestration, bronchogenic cysts, congenital adenomatoid lung malformation, neoplasms, and diaphragmatic hernia. We describe the prenatal diagnosis of hiatal hernia with ultrasonography
TL;DR: A case diagnosed at 21 weeks of gestation in which antenatal sonographic and post‐mortem radiological findings were correlated, supporting previous reports of an autosomal recessive inheritance pattern of Atelosteogenesis type II.
Abstract: Atelosteogenesis type II is a lethal chondrodysplasia characterized by severe micromelia, spinal abnormalities, talipes equinovarus, and abducted thumbs and toes. We present a case diagnosed at 21 weeks of gestation in which antenatal sonographic and post-mortem radiological findings were correlated. The patient had a recurrence of this disorder in a subsequent pregnancy which was terminated at 15 weeks, supporting previous reports of an autosomal recessive inheritance pattern. The feasibility of diagnosing the following morphological features by prenatal ultrasonography is demonstrated: coronal clefts of the vertebral bodies, metaphyseal and epiphyseal abnormalities, spinal deviations such as cervical kyphosis and a horizontal sacrum, additional ossification centres in the pelvis, and preaxial deviation of the thumbs and toes. The differential diagnosis of this disorder from other skeletal dysplasias with similar features is discussed.
TL;DR: Transvaginal ultrasound was performed upon admission of 127 patients with a clinical suspicion of ectopic pregnancy in association with human chorionic gonadotropin (hCG) determination to identify 25/42 tubal pregnancies with a positive predictive value and a specificity of 93%.
Abstract: Transvaginal ultrasound was performed upon admission of 127 patients with a clinical suspicion of ectopic pregnancy in association with human chorionic gonadotropin (hCG) determination. Failure to visualize with sonography an intrauterine gestational sac with an hCG level superior to 1000 mIU/ml identified 25/42 tubal pregnancies with a positive predictive value of 86% and a specificity of 93%. Abnormal adnexal findings occurred in 95% of the ectopic pregnancies. Extrauterine gestational sacs with or without embryos could be confidently detected in 19 ectopic pregnancies (45%). A complex adnexal mass was seen in 19 cases and yielded a positive predictive value of 90% (19/21). Adnexal gestational sacs and complex masses were seen more frequently in those ectopic pregnancies with an hCG level above 1000 mIU/ml but the difference was not significant (100% versus 78%). Simple adnexal cysts were found more frequently in intrauterine pregnancies, and fluid in the cul-de-sac was also not indicative of ectopic pregnancy (positive predictive value, 29%). Transvaginal ultrasound has a primary role in the diagnosis of ectopic pregnancy. The combined use of uterine and adnexal sonography associated with elevated hCG levels allows a definitive diagnosis in the vast majority of cases at a very early stage, when the chances for a successful conservative treatment are greater.
01 Jan 1992
TL;DR: Colonization of the amniotic cavity with Candida tropicalis was diagnosed in a woman with preterm labor and intact membranes and the infant survived and was discharged home 2 months after birth.
Abstract: Colonization of the amniotic cavity with Candida tropicalis was diagnosed in a woman with preterm labor and intact membranes. Treatment with ketoconazole and amphotericin B failed to eradicate the microorganism from the amniotic cavity. Tocolysis was administered and was considered successful in prolonging the pregnancy for 11 days after the initiation of treatment. There was no clinical or microbiological evidence of neonatal infection. The infant survived and was discharged home 2 months after birth.
TL;DR: The amniotic fluid Gram stain showed a sensitivity, specificity, and positive predictive value of endomyometritis of 88%, which was higher than other clinical determinants evaluated and can therefore be used in clinical management by starting antibiotic treatment at the time of cesarean delivery.
Abstract: The objective of this prospective study was to determine the value of the amniotic fluid Gram stain in identifying patients at high risk for postcesarean endomyometritis. Intraoperative samples of amniotic fluid were obtained from 151 patients undergoing nonelective cesarean section. Gram stains were performed and analyzed for the presence of bacteria and white blood cells (WBCs). Endomyometritis occurred in 55/151 (36%) of patients. Positive Gram stain, defined as the presence of any bacteria in any high power field, occurred in 29/55 (53%) of patients with endomyometritis as compared to 4/96 (4.2%) of patients without endomyometritis (P < 0.001). The amniotic fluid Gram stain showed a sensitivity of 53%, specificity of 96%, a negative predictive value of 78%, and a positive predictive value of endomyometritis of 88%, which was higher than other clinical determinants evaluated. A positive test can therefore be used in clinical management by starting antibiotic treatment at the time of cesarean delivery. ...