Proposal To Aggressively Treat Infection-mediated Premature Delivery

Dr. James McGregor of the US again took center stage, with his proposal to aggressively treat infection-mediated premature delivery. Citing published studies to demonstrate that 1/3 to 1/2 of all prematurity is infection-related, Dr. McGregor then counted down the six infectious entities which he felt, in spite of limited clinical experience for the most part, were prime targets for this practical and money saving crusade.

Dr. McGregor suggested that significant inroads could be made against premature delivery and its monetary and human costs by screening "early and often" during pregnancy, starting at the first prenatal visit, for:

• gonorrhea;
• asymptomatic bacteriuria;
• Group B streptococcus associated with asymptomatic bacteriuria;
• trichomoniasis;
• chlamydial cervicitis;
• bacterial vaginosis.

According to Dr. McGregor, the screening and treatment of these entities during pregnancy would cost about as much as the cost of 12 minutes for a premature neonate in the neonatal intensive care unit. Dr. McGregor then went on to challenge the audience to screen and treat for these infections as a preparation for pregnancy, initiating such screening perhaps 6 months prior to a planned pregnancy, for the optimal benefit. Again, Dr. McGregor explained that, although the science behind this protocol seems solid, aiming at reducing the inflammatory mediators which place patients at risk for premature labor and delivery, there is not, as yet, appropriate evidence to support all of these recommendations.

Dr. McGregor summed up his presentation by citing published data which indicated that treatment of a gravida in labor, and the prevention of her delivery (in the face of an otherwise healthy and stable fetus), increased the infant's survival by 2% for every day gained in utero, and increased the infant's normalcy beyond survival by 1% per day gained in utero. Thus, if a baby were held in utero for 10 days, there would be a gain of 20% in mortality and 10% in survival intactness. A worthwhile goal.

References:

OBGYN.net Disclaimer: This is an Opinion by the author In the UK they are currently involved in a huge multicentre study into the relationship between infection and PPROM / prem labour (ORACLE Study). The case is not clearly proven and more importantly the ability to stop the bad outcomes by intervening with antibiotics is not clearly established.

Reporting for OBGYN.net at ESIDOG, Dr. Joseph Pastorek is a private consultant in Louisiana, in the Greater New Orleans area, and a long-time researcher and speaker on obstetric and gynecologic infectious disease topics. He is also the Louisiana State representative for OBGYN.net. Any immediate comments or feedback on the conference may be directed to Dr. Pastorek at DoctorJoe@aol.com.