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The Role of Infection in the Etiology of Preterm Birth

The hypothesis that infection induces or is a precursor to preterm birth or premature rupture of the membranes (PROM) was examined in a prospective study of 193 randomly selected pregnant women. The prognostic significance of factors suggesting infection of the uterine cavity prior to pregnancy, such as history of pelvic inflammatory disease (PID), history of intrauterine contraceptive device (IUD) usage, multiple sex partners, and presence of antisperm antibodies, was investigated in relation to PROM and preterm birth. Sexual activity, a potential vehicle for bacterial exchange, was also charted throughout pregnancy by monthly interviews. Immunologic tests on each patient and cultures of the cervix for aerobic and anaerobic bacteria and chlamydia were obtained at the first visit occumng during 6-14 weeks gestation and repeated at 36 weeks. The results suggest that infection may indeed cause PROM or preterm birth. Several variables indicative of a prepregnant infection of the uterine cavity were positively associated with pregnancy complications. A past history of PID was associated with pregnancies of shorter duration and amnionitis. Out of the 22 patients with a history of PID, 9 (40.9%) ended their pregnancies before the 37th week. Out of the 171 patients without a history of PID, 29 (17%) ended their pregnancies before the 37th week (p=O.o04). The incidence of amnionitis in these two groups was 10.5% and 0.6%, respectively (p=O.o06). Fourteen (36.8%) of the 38 IUD users and 24