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Observational Study
. 2023 Sep;130(10):1238-1246.
doi: 10.1111/1471-0528.17479. Epub 2023 Apr 17.

Pathogens identified in the internal tissues and placentas of stillbirths: results from the prospective, observational PURPOSe study

Sheetal U Harakuni  1 , Manjunath S Somannavar  1 , Najia K Ghanchi  2 , Imran Ahmed  2 , Afia Zafar  2 , Jean Kim  3 , Shiyam Sunder Tikmani  2 , Kay Hwang  3 , Sarah Saleem  2   3 , Shivaprasad S Goudar  1 , Sangappa Dhaded  1 , Gowder Guruprasad  4 , Haleema Yasmin  5 , S Yogeshkumar  1 , Anna Aceituno  3 , Robert M Silver  6 , Elizabeth M McClure  3 , R L Goldenberg  7 ; PURPOSe Investigators
Collaborators, Affiliations
Observational Study

Pathogens identified in the internal tissues and placentas of stillbirths: results from the prospective, observational PURPOSe study

Sheetal U Harakuni et al. BJOG. 2023 Sep.

Abstract

Objective: To examine internal organ tissues and placentas of stillbirths for various pathogens.

Design: Prospective, observational study.

Settings: Three study hospitals in India and a large maternity hospital in Pakistan.

Population: Stillborn infants delivered in a study hospital.

Methods: A prospective observational study.

Main outcome measures: Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths.

Results: Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%).

Conclusions: In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.

Keywords: India; PCR; Pakistan; infection; minimall invasive tissue sampling; placenta; stillbirth.

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References

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