Utero-adnexal damage in septic abortion. Histopathological study on 91 cases

Septic abortion represents the main causes of abortion-induced maternal death. Hysterectomy may represent a beneficial therapeutic solution for septic abortion, nevertheless with irreversible effects on a woman's reproductive condition. The study analyzes the anatomopathological damage found in ninety-one patients hospitalized for septic abortion. The patients were admitted to the "Dr. D. Popescu" Clinical Hospital, Timisoara, between 1980-1989 and 1999-2008; hysterectomy was performed in all the cases to eliminate uterine sepsis responsible for the emerging complications.

[Spontaneus abortion caused by Listeria monocytogenes--report of three cases]

This paper describes three cases of spontaneous abortion caused by Listeria monocytogenes which were diagnosed during the outbreak of listeriosis in late 2006. Both clinical and morphological features were highly consistent. The abortion between 19 and 20 weeks of gestation was preceded by high maternal fever. The fetal disease was miliary widespread with involvement of adrenals, liver and lungs in particular. There was always present a pustular rash. Histological examination of the placentas revealed acute chorioamnionitis with massive growth of gram-positive rods in the amnion in all cases. Acute villitis and intervillous microabscesses were additionally noted in one case. The diagnosis in all reported cases was not established until fetal autopsy. The final diagnosis was confirmed by microbiological examination using samples submitted during the autopsy examination.

A ‘minimum dose’ of lipopolysaccharide required for implantation failure: assessment of its effect on the maternal reproductive organs and interleukin-1α expression in the mouse

Genital tract infections caused by gram-negative bacteria induce abortion and are one of the most common complications of human pregnancy. This study was carried out to decipher the mechanism of gram-negative bacterial lipopolysaccharide (LPS)-induced pregnancy loss, using a mouse (Park strain) model. Since many of the biological effects of LPS are mediated by interleukin (IL)-1α, the role of IL-1α in LPS-induced pregnancy loss was studied. Pregnant female animals were injected intra-peritoneally (i.p.) with different doses (1 to 50 μg) of LPS from Salmonella minnesota Re-595, on day 0.5 of pregnancy. We found that 250 μg/kg body weight (i.e. 5 μg/female mouse) of LPS when given on day 0.5 of pregnancy was the ‘minimum dose’ (MD) required to completely inhibit the implantation of the blastocyst in the mouse. The effect of this dose on the pathophysiology of the various reproductive organs (i.e. uterus, ectoplacental cones, developing fetus, ovaries etc.) was assessed on day 14 of pregnancy. The effects of this dose on the level and pattern of expression of the proinflammatory cytokine IL-1α in the maternal uterine horns and preimplantation stage embryos were studied by RT-PCR. A single dose (100 ng/mouse) of recombinant mouse IL-1α was given i.p. to pregnant females on day 1 of pregnancy to study its effect on implantation. Our results show that treatment of the pregnant animals with LPS may alter cell proliferation and induce leukocyte infiltration, degeneration of luminal glandular epithelium, and hyperplasia in the various reproductive organs, and may also alter both embryonic and uterine IL-1α expression. IL-1α administration also caused implantation failure similar to that of LPS. The observations suggest that the determined MD of LPS may alter the expression of developmentally important proinflammatory cytokines such as IL-1α, which could, in turn, inhibit the normal processes of blastocyst implantation. Therefore, it is proposed that the LPS-induced histopathological alterations in the various reproductive organs of pregnant animals could be mediated by IL-1α and this may be one of the causes of failure of blastocyst implantation in the mouse.

Clostridium welchii infection following amniocentesis: a case report and review of the literature

We report a case of severe Clostridium welchii infection following amniocentesis with septicaemia, haemolysis, DIC, pulmonary oedema and renal failure. Full recovery occurred following aggressive conservative management using antibiotics, endometrial curettage and intensive monitoring. The patient retained her uterus and had a successful pregnancy two years later although caesarean section for uterine rupture was required. Conservative management with conservation of the uterus and ovaries may be a safe and effective option in the management of severe Clostridium infections, using antibiotics, endometrial curettage and multidisciplinary team input.

Host adapted serotypes of Salmonella enterica

Salmonella constitutes a genus of zoonotic bacteria of worldwide economic and health importance. The current view of salmonella taxonomy assigns the members of this genus to two species: S. enterica and S. bongori. S. enterica itself is divided into six subspecies, enterica, salamae, arizonae, diarizonae, indica, and houtenae, also known as subspecies I, II, IIIa, IIIb, IV, and VI, respectively [1]. Members of Salmonella enterica subspecies enterica are mainly associated with warm-blooded vertebrates and are usually transmitted by ingestion of food or water contaminated by infected faeces. The pathogenicity of most of the distinct serotypes remains undefined, and even within the most common serotypes, many questions remain to be answered regarding the interactions between the organism and the infected host.

Salmonellosis manifests itself in three major forms: enteritis, septicaemia, and abortion, each of which may be present singly or in combination, depending on both the serotype and the host involved. Although currently over 2300 serovars of Salmonella are recognized, only about 50 serotypes are isolated in any significant numbers as human or animal pathogens [2, 3] and they all belong to subspecies enterica. Of these, most cause acute gastroenteritis characterized by a short incubation period and a severe systemic disease in man or animals, characterized by septicaemia, fever and/or abortion, and such serotypes are often associated with one or few host species [4–6].

It is the intention of this review to present a summary of current knowledge of these host-adapted serotypes of S. enterica. The taxonomic relationships between the serotypes will be discussed together with a comparison of the pathology and pathogenesis of the disease that they cause in their natural host(s). Since much of our knowledge on salmonellosis is based on the results of work on Typhimurium, this serotype will often be used as the baseline in discussion. It is hoped that an appreciation of the differences that exist in the way these serotypes interact with the host will lead to a greater understanding of the complex host–parasite relationship that characterizes salmonella infections.

[Septic abortion in Campylobacter jejuni infection]

Case report of a 24 year old woman II G/I P with enterocolitis and septicaemia caused by Campylobacter jejuni (C.) in the following time abortion at 16 weeks of gestation. Diagnostics, therapy, review of literature.

A retrospective study of bovine abortions associated with Bacillus licheniformis

A retrospective study of bovine abortions associated with Bacillus licheniformis is described. The material consisted of 2445 bovine abortions submitted for diagnostics from 1986 through 1993. Initially, B. licheniformis had been isolated from 81 cases. Sections of these cases were re-examined microscopically and immunohistochemically by a PAP technique using a primary antibody against B. licheniformis. Of these abortions, 47 were most likely associated with B. licheniformis as tissue lesions with immunostained bacteria were present in these. In the remaining cases the diagnosis may not have been established due to the lack of sufficient materials, or the isolation of the bacterium was considered to be a result of contamination. In four cases concomitant infections with B. licheniformis and bovine virus diarrhoea virus were present. Abortions caused by B. licheniformis were predominantly seen during the winter months and in late pregnancy. The most common lesions were necrotizing placentitis followed by fetal multifocal suppurative bronchopneumonia. Immunohistochemically, B. licheniformis was demonstrated in association with tissue lesions and intracellularly in trophoblasts. The pattern of bacterial isolations, especially from the placenta, lungs, and abomasal contents, combined with the histological findings points to B. licheniformis abortions as being of haematogenous origin with subsequent transplacental spread to the fetus.

[Septic cervical pregnancy. A case report]

One clinical case of cervical pregnancy studied at the General Hospital of Acapulco, Guerrero, México, is presented clinically it was manifested as septic abortion and diagnosed by ultrasonography. In the past 12 years of establishment, 30,000 deliveries have been recorded and during this period, only four well documented cases were found and two of the previously reported by one us. Only two cervical pregnancy presenting as abortion, a relationship not emphasized in literature, was made in 1975.

Fetal listeriosis during the second trimester of gestation

Listeriosis is common and is implicated in about 3% of second-term abortions examined in our laboratory. Maternal fever was followed rapidly in all instances by the expulsion of a nonmacerated fetus. Chorioamnionitis was always present and was associated with placental microabscesses. Leukocytic infiltrates were frequent in fetal tissues, being present in adrenal, lung, and skin. Listeria monocytogenes was isolated from 8 of the 205 abortions that had microbiological cultures (3.9%). The clinical features and morphological lesions were so characteristic that the diagnosis of listeriosis could be made in 5 of the 217 fixed abortuses received during the same period, but without culture. In contrast to the third trimester of pregnancy, there were no inflammatory lesions in the central nervous system in our small series.

Hysterectomy for septic abortion--is bilateral salpingo-oophorectomy necessary?

Ovarian conservation at the time of hysterectomy for complicated septic abortion is important in this young population group. In a retrospective study, the histological evaluation of the ovaries of 25 patients were compared with the macroscopic description in the operation reports. In 72.3% of the ovaries examined there was no infection. None of the ovaries described clinically as normal at laparotomy showed histological signs of infection. The clinical assessment of infected ovaries was false-positive in 40% of cases but there was no false-negative decision-making. It is concluded that ovaries which appear normal at hysterectomy for septic abortion should be conserved.

Listeriosis and recurrent abortion in a renal transplant recipient

A 29-year-old farmer's wife had received a kidney from her brother (of identical HLA type) at the age of 22 years. She was afterwards immunosuppressed with prednisolone and azathioprine. Her first pregnancy had been uneventful but the second and third had terminated spontaneously at 15 and 24 weeks gestation respectively. Following the third pregnancy, Listeria monocytogenes (serotype 4) was grown from the fetus, the placenta and maternal blood. Over the next 18 months, antibody titres which were assessed by an IgG indirect immunofluorescent antibody assay remained high. When the patient became pregnant for a fourth time, 9 months after her second abortion, 250 mg ampicillin were administered three times daily for the remaining duration of the pregnancy. A second child was successfully delivered by Caesarean section at 39 weeks' gestation.

Chronic myeloid leukemia presenting as a gynecological emergency

An unusual case of chronic myeloid leukemia presenting to the gynecological unit as a case of septic abortion is presented. Though history and clinical examination suggested the possibility of double pathology of septic abortion and chronic myeloid leukemia, histology of the products removed from the uterus showed it to be leukemic deposits. The diagnosis of leukemia was confirmed by marrow aspiration (trephine biopsy). Careful clinical examination and systematic investigation helped in diagnosing the pathology and to treat her appropriately.

Abortion in sheep caused by a nonclassified, anaerobic, flagellated bacterium

Twenty-eight pregnant ewes were inoculated IV with approximately 6 X 10(8) nonclassified, anaerobic, flagellated bacteria (NAFB) that had been isolated from an aborted lamb. Abortion occurred in 3 of the ewes and 1 ewe gave birth to a weak lamb. The remaining 24 ewes and 3 other ewes inoculated orally with NAFB did not develop clinical signs of illness. Suppuration and vasculitis were seen in the placentas of the 3 aborted lambs, 1 of which had necropurulent hepatitis indistinguishable from that usually attributed to Campylobacter fetus infection. The NAFB was isolated from fetal placenta, abomasal content, or internal organs of 2 aborted lambs and the weak lamb. A morphologically similar organism was seen in the abomasal content of the other aborted lamb, but the organism did not grow on bacteriologic culture medium. Therefore, in susceptible pregnant ewes, NAFB can cause fetal placentitis and hepatitis and subsequent birth of weak lambs or abortion.

Ovine abortion and neonatal death due to toxoplasmosis in Montana

Of 33 ewes in a flock in Montana, 6 aborted or gave birth to weak lambs, which died within 2 days after birth. Two lambs and a placenta from 1 ewe as well as 1 lamb from another ewe were submitted for diagnosis. Focal necrotizing placentitis, focal pneumonia, focal hepatitis, focal interstitial nephritis, and focal nonsuppurative encephalitis were seen in tissue sections from 2 of the lambs. Toxoplasma gondii was found in smears and sections of the placenta and in sections of lung from 1 lamb. Mice inoculated with tissues from a lamb developed dye test antibodies to T gondii. Eleven of 12 ewes from the same flock had dye test antibody titers of 1:16 or more, and titers were 4-fold higher in aborting ewes than in ewes with normal lambs.

Bilateral tubal pregnancy with vaginal delivery

A 26-year-old woman was admitted with a diagnosis of septic incomplete abortion. Subsequently she was discovered to have bilateral tubal ectopic pregnancies. The right tube was not badly damaged. Its contents were removed by linear salpingotomy and the tube was repaired. Fifteen months later the patient delivered a live infant.

Correlations between clinical and postmortem findings in listeriosis

Clinical data were correlated with postmortem findings in 14 cases of fatal listeriosis in adults and 23 cases of listeriosis during pregnancy and the neonatal period. Most children born with congenital listeriosis showed the typical morphological picture of granulomatosis infantiseptica. Occasionally no pathological changes were demonstrable. In adult patients the morphological lesions were those of non-specific purulent meningoencephalitis or septicemia. Sometimes encephalitis with abscesses in the brain was found.

[Various problems concerning maternal mortality during pregnancy]

In the autopsy material of the Department of Forensic Medicine of the Semmelweis Medical University--90,000 cases in 25 years (1950-1975)--508 cases of death in the period of gestation have occurred. Author have analysed this material and have established, that in every second case the death occurred due to criminal abortion, in every fifth case due to the complications of the pregnancy and in every third case due to the complications of delivery. By means of trend-calculations it was further established that in the autopsy material of the Department the number of the sudden natural death of women in the reproductive age during the 25 years remained on the same level, but the number of death cases connected with gestation decreased. In the latter group: the number of death cases due to abortion and complications of pregnancy decreased significantly, number of lethal cases due to complications of delivery remained at the same level. Data of the analysis are compared to the data reported in the literature. Some questions--the cause of the death, the criminality when abortions are concerned, questions of the treatment and the responsibility of physicians are also discussed. These investigations seem to evidence that on the base of the evaluation of a large autopsy material the legal medicine can reveal valuable data for the preventive medicine.