臨床婦人科産科72巻1号

2018年01月発行

合併増大号　今月の臨床 産婦人科感染症の診断・管理─その秘訣とピットフォール

早産と周産期感染症

絨毛膜羊膜炎と周産期感染

著者： 大槻克文¹

所属機関： ¹昭和大学江東豊洲病院周産期センター

ページ範囲：P.114 - P.124

文献概要

●腟内の常在菌ならびに病因菌は多岐にわたっており，早産発症までの病態を複雑にしている．

●早産予防を目的とした細菌性腟症のスクリーニング検査を行う場合には，妊娠20週未満に行う．

●臨床的絨毛膜羊膜炎の診断基準を満たさない場合でも，絨毛膜羊膜炎が存在する可能性を常に認識して対応することが求められる．

参考文献

1）Keelan JA, et al : Cytokines, Prostaglandins and parturition ; a review. Placenta 24（Suppl A） : S33─46, 2003

2）Goldenberg RL, et al : Intrauterine infection and preterm delivery. N Engl J Med 342 : 1500─1507, 2000

3）Taylor-Robinson D, et al : Genital mycoplasma infections. Wien Klin Wochenschr 109（14─15） : 578─583, 1997

4）Bennett PR, et al : The mechanisms of preterm labor ; common genital tract pathogens do not metabolize arachidonic acid to Prostaglandins or to other eicosanoids. Am J Obstet Gynecol 166 : 1541─1545, 1992

5）McGregor JA, et al : Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase ; results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 170 : 1048─1059 ; discussion 1059─1060, 1994

6）Cox SM, et al : Assay of bacterial endotoxin（lipopolysaccharide）in human amniotic fluid : potential usefulness in diagnosis and management of preterm labor. Am J Obstet Gynecol 159 : 99─106, 1988

7）Andrews WW, et al : Amniotic fluid interleukin-6 ; correlation with upper genital tract microbial colonization and gestational age in women delivered after spontaneous labor versus indicated delivery. Am J Obstet Gynecol 173 : 606─612, 1995

8）母子衛生研究会 : 母子保健の主なる統計．2015

9）Knox JR, et al : Pratt, Different modes of vancomycin and D-alanyl-D-alanine peptidase binding to cell wall peptide and a possible role for the vancomycin resistance protein. Antimicrob Agents Chemother 34 : 1342─1347, 1990

10）Lockwood CJ : Predicting premature delivery ; no easy task. N Engl J Med 346 : 282─284, 2002

11）Hillier SL, et al : Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 333 : 1737─1742, 1995

12）日本産婦人科学会，日本産婦人科学会 : 周産期委員会報告．早産リスク因子の解明と具体的な予防法確立に関する小委員会．日産婦会誌62 : 1, 2010

13）Shimano S, et al : Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan. J Obstet Gynaecol Res 30 : 230─236, 2004

14）CQ601妊娠中の細菌性腟症の取り扱いは？　産婦人科診療ガイドライン─産科編2017（日本産科婦人科学会/日本産婦人科医会 編集・監修）．pp335─357, 日本産科婦人科学会，2017

15）McDonald HM : Brocklehurst, and A. Gordon, Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev（1）: CD000262, 2007

16）Brocklehurst P, et al : Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev（1）: CD000262, 2013

17）齋藤　滋，他 : 早産のリスク因子の解明と具体的な予防法確立に関する小委員会．日産婦会誌63 : 1327─1329, 2011

18）島野　敏 : 【周産期医療とinflammatory response】細菌性腟症．周産期医学39 : 681─690, 2009

19）Leitich H, et al : Bacterial vaginosis as a risk factor for preterm delivery : a meta-analysis. Am J Obstet Gynecol 189 : 139─1347, 2003

20）Romero R, et al : Infection and labor. V. Prevalence, microbiology, and clinical significance of intraamniotic infection in women with preterm labor and intact membranes. Am J Obstet Gynecol 161 : 817─824, 1989

21）Hitti J, et al : Broad-spectrum bacterial rDNA polymerase chain reaction assay for detecting amniotic fluid infection among women in premature labor. Clin Infect Dis 24 : 1228─1232, 1997

22）Markenson GR, et al : The use of the polymerase chain reaction to detect bacteria in amniotic fluid in pregnancies complicated by preterm labor. Am J Obstet Gynecol 177 : 1471─1477, 1997

23）Oyarzun E, et al : Specific detection of 16 micro-organisms in amniotic fluid by polymerase chain reaction and its correlation with preterm delivery occurrence. Am J Obstet Gynecol 179 : 1115─1119, 1998

24）Taylor-Robinson D : The future of bacterial vaginosis-related research. Int J Gynaecol Obstet 67（Suppl 1） : S35─38, 1999

25）Amsel R, et al : Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74 : 14─22, 1983

26）Nugent RP, et al : Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29 : 297─301, 1991

27）Verstraelen H, et al : Modified classification of Gram-stained vaginal smears to predict spontaneous preterm birth ; a prospective cohort study. Am J Obstet Gynecol 196 : 528. e1─6, 2007

28）Leitich H, et al : Antibiotic treatment of bacterial vaginosis in pregnancy ; a meta-analysis. Am J Obstet Gynecol 18 : 752─758, 2003

29）Workowski KA, et al : Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 64（RR-03） : 1─137, 2015

30）Yudin MH, et al : Clinical and cervical cytokine response to treatment with oral or vaginal metronidazole for bacterial vaginosis during pregnancy ; a randomized trial. Obstet Gynecol 102 : 527─534, 2003

31）Sangkomkamhang US, et al : Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev（2） : CD006178, 2015

32）Mastromarino P, et al : Bacterial vaginosis ; a review on clinical trials with probiotics. New Microbiol 36 : 229─238, 2013

33）Otsuki K, et al : Effects of lactoferrin in 6 patients with refractory bacterial vaginosis. Biochem Cell Biol 95 : 31─33, 2017

34）Cotch MF, et al : Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study GrouSex Transm Dis 24 : 353─360, 1997

35）Yoon BH, et al : The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor. Am J Obstet Gynecol 189 : 919─924, 2003

36）Elliott B, et al : Maternal gonococcal infection as a preventable risk factor for low birth weight. J Infect Dis 161 : 531─536, 1990

37）Vile Y, et al : Chlamydia trachomatis infection in prelabour amniorrhexis. Br J Obstet Gynaecol 104 : 1091─1093, 1997

38）Andrews WW, et al : The Preterm Prediction Study ; association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. Am J Obstet Gynecol 183 : 662─668, 2000

39）Klein LL, et al : Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth. Am J Obstet Gynecol 190 : 1493─1502, 2004

40）Hillier SL, et al : A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 319 : 972─978, 1988

41）Yoon BH, et al : The relationship among inflammatory lesions of the umbilical cord （funisitis）, umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol 183 : 1124─1129, 2000

42）Hillier SL, et al : Microbiologic causes and neonatal outcomes associated with chorioamnion infection. Am J Obstet Gynecol 165（4 Pt 1） : 955─961, 1991

43）Garite TJ, et al : The use of amniocentesis in patients with premature rupture of membranes. Obstet Gynecol 54 : 226─230, 1979

44）Feinstein SJ, et al : Amniocentesis with premature rupture of membranes. Obstet Gynecol 68 : 147─52, 1986

45）Romero R, et al : A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes. Am J Obstet Gynecol 169 : 839─851, 1993

46）Andrews WW, et al : Infection and preterm birth. Am J Perinatol 17 : 357─365, 2000

47）Yoon BH, et al : Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes. Obstet Gynecol 88 : 1034─1040, 1996

48）Lencki SG, et al : Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis. Am J Obstet Gynecol 170（5 Pt 1）: 1345─1351, 1994

49）King J, et al : Antibiotics for preterm labour with intact membranes. Cochrane Database Syst Rev（2） : CD000246, 2000

50）Kenyon SM, et al : Boulvain, and J. Neilson, Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev（2） : CD001058, 2003