[The amniotic infection syndrome and premature rupture of the amnion. Manifest and threatening unspecific intra-uterine infections of the last third of pregnancy (author's transl)]

Abstract

In the last third of pregnancy the unspecific bacterial diseases of placenta, umbilical cord and membranes differ from those in earlier months [154; 155; 85]. There is a parallel change in the localization of fetal organs affected. Pathologic anatomical clarification of this led to the conceptual definition of the rare extra-amnial placental-fetal path of infection on the one hand and of primary intra-amnial infection with secondary chorion-amnionitis on the other hand and to identification of the amniotic infection syndrome as a typical entity at the end of pregnancy [19]. While the amnionic sac is closed, unspecific fetal inflammation is rare. Generally this happens only after rupture of the membranes. Since the amniotic infection syndrome often produces only minor clinical symptoms and since fetal infection probably starts early, one searched for means of assessing the risk of infection independently from symptoms. In comparative series of investigations of pregnancies with and without premature rupture of the membranes, cases of neonatal death from infection were preceded by signs of inflammation in placenta, umbilical cord and membranes. Together with the fetal and maternal infections they depended on the length of time between rupture and the onset of labor. pns. The data now available give a clear picture of the development of the inflammatory processes in mature and premature children and suffice for the assessment of fetal and maternal risks.