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21 week pregnant and have ureaplasma. Will it cause any pregnancy problem?

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I am 21 wks pregnant and have ureaplasma. I took two courses of erythromycin and still positive. Im worried if this infection causes major pregnancy problems. Is it proven evidence that it can cause pprom, stillbirth and premature labor? Should i take a third course of antibiotics?
Posted Tue, 13 Nov 2012 in Women's Health
Answered by Dr. Chakravarthy Mazumdar 4 days later

I have a basic question for you. Was ureaplasma cultured from the vaginal fluid? This is important. They are commonly present as normal vaginal flora. There is sometimes a question as to whether they really cause a problem. It is all to do with the amount of bacterial load rather than the presence of them that is important.

Yes there are a number of evidence that UTI and Sexually transmitted infections can cause premature rupture of membranes, still birth and premature labor. The question still remains within most OBGYN that what is the percentage of such complications. Definitely not every UTI and STI will lead to the above complications.

Erythromycin is drug of choice to treat and so you were. I suggest to get the culture done and start the third course. Such culture are not routinely practiced unless there is a past history of the miscarriage, pprom and still birth. You have not reported such history. Your baby is protected within amniotic membranes till the time they are not ruptured the infection will not pass the baby. We should see if you have full fledged infection or not.

Let me know if you have any more queries.
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Follow-up: 21 week pregnant and have ureaplasma. Will it cause any pregnancy problem? 13 hours later

Thankyou for your informative reply.

In order to detect the ureaplasma, they tested for PCR DNA urine. It came back as detected for Ureaplasma but not detected for Mycoplasma, Chlamydia and Gonorrheoa.

Also a mid stream urine culture was tested and there was no growth and tested for Phenylketonuria and other aspects all came back negative and within normal limits.

Hence, I have two questions:
1. As two courses of antibiotics (e-mycin) have not got rid of the ureaplasma, would you suggest to take the third course or wait?
2. Can ureaplasma go into the uterus? and will it cause respiratory tract infections for the baby when born?

Thanks so much.

Answered by Dr. Chakravarthy Mazumdar 5 hours later

If the culture is positive, whether the growth is scant or profuse. If scant no need of E-mycin. You can avoid it. Ask if your doctor would do an cervical swab culture, amniotic fluid culture and serum antibodies against Ureaplasma. If you have antibodies then you may not have negative pregnancy outcome.

Let your doctor do a vaginal fluid culture before the delivery. If the growth is still present you can be delivered under appropriate antibiotic cover. The delivery should not be delayed more than one hour after the rupture of membranes.

It is highly difficult to answer and in fact difficult to decide about the treatment by your doctor. This is because of the following facts after a thorough research involvement.

Vaginal carriage of Ureaplasma spp. is not reliably predictive of preterm labor, but there is an association with preterm labor when it is present in the amniotic fluid or placenta. This is not known in your case unless the amniotic fluid is cultured. Two recent reviews of antibiotic trials involving treatment of pregnant women who were culture positive for ureaplasmas in their vaginas concluded that there is insufficient evidence to recommend administration of antibiotics to women with ureaplasmas in the vagina to prevent preterm birth.

Studies also reported that women whose cervices were culture positive for Ureaplasma spp. and who had a high level of antibody against ureaplasmas were more likely to develop pregnancy complications than women with a negative culture and absence of antibodies. Similar investiations also reported that women with amniotic fluids that were culture positive for Ureaplasma and who had elevated antibodies were more likely to experience complications including preterm labor, low birth weight, and fetal death than women without antibody against ureaplasma spp.

Treatment of pregnant women colonized with Ureaplasma spp. with erythromycin has not shown significant differences in infant birth weight or gestational age at delivery, frequency of premature rupture of membranes, or neonatal outcome. Another major consideration is that no information concerning the efficacy of erythromycin for treating intrauterine infections is available. Though Erythromycin is first drug of choice it does not effectively penetrate the amniotic sac nor does it eradicate ureaplasmas from the cervix and vagina, probably because of the normally low vaginal pH. This might be the reason why the two courses failed.

Hope this help you. If you have any more queries I will be happy to answer else you may close this discussion and rate the answer.

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