Infection-related stillbirths: a multidisciplinary approach L. Gabrielli 1, C. Pavia 1, G. Cocchi 2, G. Caprara 3, R. Morandi 4, A. Vancini 5, A. Salerno 6, S. Ambretti 1, A. Marangoni 1, T. Lazzarotto 1 1O.U. of Clinical Microbiology, 2O.U. of Neonatology, 3O.U. of Oncology and Transplant Pathology, 4O.U. of Obstetrics and Gynecology, St. Orsola Malpighi University Hospital; 5Newborn Intensive Care Unit, 6O.U. of Pathology, Maggiore Hospital, Bologna, Italy. Background Table 1. Stillbirth Protocol. Results Figure 1. Severe fetal pneumonia. Maternal examinations Stillbirth (SB) is a common adverse From April 2014 to November 2015, 37 cases pregnancy outcome with a rate of 3-8 per Parvovirus B19, (0.3%) of SB occurred out of 11,145 births. 1000 live births in developed countries and Enterovirus, Cytomegalovirus The microbiological investigation identified a approximately 20-40 per 1000 births in Serology (HIV, syphilis, Toxoplasma gondii clear association between SB and group B developing countries. Although several only in the absence of screening during pregnancy) Streptococcus infection in two cases. The conditions and specific risk factors have been bacterium was identified in the vaginal swab Vaginal swabs Mycoplasma hominis associated with SB, in most cases it is difficult Ureaplasma urealyticum of the mother, in the placenta, blood and to identify the definitive pathway causing Bacteria and Fungi throat swab of the baby. Histological death and a significant number of SBs Placental examinations examination revealed chorioamnionitis and remain unexplained. In high-income Bacteria and Fungi severe fetal pneumonitis (Table 2) (Figure 1). countries, 10-25% of SB are caused by In one case, maternal vaginal swab and Conclusions infection. Placental biopsies Parvovirus B19, neonatal throat swab were positive for Enterovirus, We observed a fetal infection associated with Aim Cytomegalovirus Ureaplasma urealyticum. Fetal autopsy death in approximately 8% of the cases of Stillbirth examinations confirmed the infectious etiology (Table 2). SB. Ascending bacterial infection with Our aim was to study maternal, placental In eight cases, the fetal blood culture was organisms such as group B streptococcus and and neonatal samples in all cases of SB in Cardiac blood Blood culture positive for contaminating bacteria and Ureaplasma urealyticum seems to be the most order to define the relation between Mycoplasma hominis clinical and histological findings have prevalent infectious cause of SBs. Women infections and stillbirths. The results were Throat swabs Ureaplasma urealyticum identified non-infectious causes. who have bacterial vaginosis may have an then discussed in a multidisciplinary clinical Bacteria and Fungi No viral infections were observed. ascending bacterial infection, causing a audit. Maternal seroprevalence for Parvovirus B19, The evidence of an infectious aetiology for decidual and chorioamnion infection and Enterovirus, Cytomegalovirus and Material and methods a stillbirth is obtained from a careful inflammatory response. The bacteria appear Toxoplasma gondii was 57%, 11%, 70% and to traverse the membranes and infect the In Italy, SB is defined as neonates of > 22 autopsy examination with appropriate 19%, respectively. amniotic fluid infecting the fetus. The most weeks of complete gestation or weighing > serological, culture and PCR tests to Table 2. Fetal infection-related stillbirths. common pathway of attack is by way of the 500g and with Apgar scores at 0 in the first identify infectious organisms. The culture of urogenital mycoplasmas was Gest. fetal lung, probably associated with fetal Ethnic and fifth minutes and who were not actively Bacteria age Histological findings performed using the commercial kit origin breathing of contaminated amniotic fluid. resuscitated. (wks) MycoView (Zeakon Diagnostics). The At the S. Orsola-Malpighi University chorioamnionitis, Hospital and Maggiore Hospital in Bologna, detection of viruses was carried out using GBS 39 Italian severe bilateral pneumonitis Italy, microbiological investigations on commercial Real-time PCR chorioamnionitis, (ELITechGroup). Traditional culture- GBS 27 Senegal Microbiological investigation is one of the maternal, placental and fetal samples from pneumonitis based methods were used to detect pieces of the puzzle that can provide cases of SB were performed as required by Severe U. bacteria and fungi. All bacterial and 34 Morocco chorioamnionitis, elements of discussion in the the SB Protocol approved by the Emilia- urealyticum fungal isolates were identified using pneumonitis Romagna group of Microbiologists of the multidisciplinary clinical audit, as it is the MALDI-TOF mass spectrometry. AMCLI Association (Table 1). GBS: group B Streptococcus only point in which to draw conclusions. Copyright © 2016 Dott.ssa Liliana Gabrielli. E-mail: [email protected].