Showing papers by "Roberto Romero published in 1998"
TL;DR: The fetal systemic inflammatory response as a mechanism of disease is reviewed and potential interventions to control an exaggerated inflammatory response in utero are also described.
1,019 citations
TL;DR: In this article, the authors proposed that preterm labor in the setting of infection results from the actions of proinflammatory cytokines secreted as part of the fetal and/or maternal host response to microbial invasion.
514 citations
TL;DR: Patients with preterm premature rupture of membranes and microbial invasion of the amniotic cavity with U urealyticum are associated with a robust host inflammatory response in the fetal, amniotics, and maternal compartments.
217 citations
TL;DR: A role for matrix metalloproteinase-9 in the mechanisms responsible for membrane rupture in term and preterm gestations is supported, and spontaneous rupture of membranes at term is associated with a significant increase in the amniotic fluid concentrations of matrix meetallop Proteinase 9.
208 citations
TL;DR: It is proposed thatThrombophilia leading to thrombosis in the maternal and/or fetal circulations is a significant mechanism of disease during pregnancy.
Abstract: The purpose of this study was to examine the relationship among adverse pregnancy outcome, the presence of thrombotic lesions in the placenta, and the frequency and type of laboratory abnormalities consistent with the presence of a thrombophilic state. A retrospective cohort study was designed to determine the frequency of laboratory abnormalities consistent with thrombophilia among patients with thrombotic lesions of the placenta and adverse pregnancy outcome. The workup for a thrombophilic state included anticardiolipin antibodies, lupus anticoagulant, protein C and antithrombin III activities, protein S total and free, activated protein C resistance ratio, and Factor V Leiden mutation. Thrombotic lesions were identified by histopathologic examination of the placenta. Thirteen patients met the study criteria over an 11-month period. Seven patients were heterozygous for Factor V Leiden mutation (53.8%). Protein S deficiency was found in three cases (23.0%), and no hemostatic abnormality was detected in three cases (23.0%). Mothers with an adverse pregnancy outcome and thrombotic lesions of the placenta often have laboratory abnormalities indicative of a thrombophilic state. We propose that thrombophilia leading to thrombosis in the maternal and/or fetal circulations is a significant mechanism of disease during pregnancy.
170 citations
TL;DR: It is proposed that in utero aspiration of fluid with high concentration of pro-inflammatory mediators may contribute to the lung injury responsible for the development of bronchopulmonary dysplasia.
168 citations
TL;DR: Microbial invasion of the amniotic cavity with U urealyticum is a risk factor for impending preterm delivery and adverse perinatal outcome in women with preterm labor.
148 citations
TL;DR: In this paper, the authors used stepwise linear regression (SLR) to predict the gestational age for singleton, twin, and triplet gestations from 14 to 22 weeks.
120 citations
TL;DR: An elevation in fetal plasma cortisol but not dehydroepiandrosterone sulfate was followed by the onset of spontaneous preterm labor in patients with preterm premature rupture of the membranes.
85 citations
TL;DR: To determine if a fall in serum progesterone concentrations occurs before the onset of bacterial product-induced preterm parturition in animals, pregnant mice at day 15 and timed-pregnant rabbits were inoculated transcervically with a suspension of E. coli to cause an ascending intrauterine infection.
Abstract: Bacterial products are thought to induce labor by stimulating the production of pro-inflammatory cytokines and prostaglandins in gestational tissues, leading to the onset of preterm parturition. Progesterone withdrawal is a prerequisite of parturition in many species. Yet a role for progesterone in the mechanisms responsible for preterm parturition, in the setting of infection, is unclear. The current studies were conducted to determine if a fall in serum progesterone concentrations occurs before the onset of bacterial product-induced preterm parturition in animals.Accordingly, pregnant mice at day 15 (70% gestation) were injected i.p. with Escherichia coli lipopolysaccharide (LPS; 50 μg/mouse) and timed-pregnant rabbits were inoculated transcervically with a suspension of E. coli to cause an ascending intrauterine infection. Control animals in both groups received equal volumes of sterile phosphate-buffered saline (PBS) solution. Blood specimens were collected at regular intervals and serum progesterone ...
71 citations
TL;DR: This is the first in vivo endoscopic visualization of the site of spontaneous rupture of membranes from within the uterine cavity and there appear to be time-related changes in the morphologic characteristics of the sites of rupture.
TL;DR: Treatment modalities that have been applied to patients who have preterm labor (PTL) and preterm premature rupture of membranes have been found to be of limited value in reducing both the rate of prematurity and of perinatal mortality and morbidity.
Journal Article•
TL;DR: Administration of antibiotics to patients with PROM at term results in a significant reduction in the rate of maternal infection-related morbidity.
Abstract: Background/objective Subclinical microbial invasion of the amniotic cavity in patients with premature rupture of membranes (PROM) at term occurs in 34% of cases and is a risk factor for puerperal endometritis. This study was conducted to determine whether antibiotic administration to women with PROM at term could reduce the rate of infection-related morbidity. Study design Between August 1990 and December 1993, patients with term PROM were randomly allocated to receive either cefuroxime-clindamicin or placebo. Results Fifty-five patients received intravenous antibiotics and 50 patients received placebo. Patients allocated to the antibiotic group had a lower incidence of maternal infection-related morbidity (clinical chorioamnionitis and puerperal endometritis) than patients who received placebo (1.8% (1/55} vs. 16% (8/50}, respectively, p < 0.05). No significant differences were found in other maternal and neonatal outcomes between the two groups. Conclusion Administration of antibiotics to patients with PROM at term results in a significant reduction in the rate of maternal infection-related morbidity.
TL;DR: The results suggest that gravidine may play a permissive role in the interplay with prostanoids in the mechanism of parturition.
Abstract: OBJECTIVE What is the significance of gravidine, a phospholipase A2 inhibitor, in parturition? METHODS Gravidine concentrations were measured in amniotic fluid obtained by transabdominal amniocentesis from women in labor at term and not in labor using a sensitive and specific ELISA. RESULTS (1) Amniotic fluid gravidine concentrations were lower in the presence than in the absence of labor. (2) Gravidine concentrations in the amniotic fluid of the forebag were higher than in the amniotic fluid of the upper compartment. (3) There was a positive correlation between gestational age and amniotic fluid gravidine concentrations. (4) No such correlation could be demonstrated between cervical dilatation and amniotic fluid gravidine concentrations. CONCLUSION These results suggest that gravidine may play a permissive role in the interplay with prostanoids in the mechanism of parturition.