الفهرس 
ChlamydiaOnly 14 pages are availabe for public view
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Abstract
Preterm delivery (PTD) is defined as the birth of an infant at less than 37 weeks of gestation. Preterm labor is usually defined as regular contractions accompanied by cervical changes occurring at less than 37 weeks’ gestation (Tucker et al., 1991).
Regular uterine contractions should be at least two every 10 minutes, while cervical changes refers to either dilatation (2 cm or more) or effacement (cervical length of 1 cm or less) (Arias 1993).
According to the Egyptian Ministry of Health statistics, the incidence of prematurity in Egypt reached up to 13.6% in 1995. The etiology of spontaneous preterm labor and preterm birth is multi-factorial but there is overwhelming evidence that infection is an important cause, probably accounting for up to 30% of cases, Studies demonstrates associations between specific microorganisms and preterm labor. These include Neisseria gonorrhea, group B strepto-cocci, and Chlamydia trachomatis.
Although abundant evidence is now available to link certain genital tract infections with spontaneous preterm birth, investigations of the association between C. trachomatis infection of the female genital tract during pregnancy and subsequent spontaneous preterm birth have produced mixed results. Some reports have linked the presence of maternal Chlamydia infection with low birth weight, premature birth, premature rupture of membranes, and even an increased risk of perinatal death.
This study was designed in a prospective manner to search for the Link between Chlamydial infection (particularly C.trachomatis) and development of preterm labor among Egyptian primigravidae, and the role of antichlamydial treatment in decreasing the rate of development of preterm labor.
The study population was 1200 pregnant women, primigravidae, from 16 to 20 weeks gestational age; they were divided into two groups randomly, 1) Study group (n=600): pregnant women who received antichlamydial treatment in the form of Azithromycin 1 gram single oral dose before completed 20 weeks gestational age and their partners properly before further follow up. 2) Control group (n=600): pregnant women who did not receive any anti-chlamydial treatment (placebo), and followed up to term or developing of preterm labor, 36 cases out of 511 pregnant women who received antichlamydial treatment developed preterm labor and 48 out of 466 pregnant women who received placebo developed preterm labor.
These results point out that the study group women had a lower rate of development of preterm labor. There was no significant statistical difference between the study and control groups as regards development of preterm labor. These results clarify that Chlamydia trachomatis infection may be a precipitating factor or an aggravating factor but not a vital etiological factor in the development of preterm labor.
Although based upon a prospective population based cohort, this study still has some limitations. A larger multi-centric, more population based, double-blinded studies including more women with different socioeconomic backgrounds and with a better recruitment system should be conducted in order to cast more light on this issue.
This study suggests a possible beneficial effect of using anti-chlamydial treatment early in pregnancy as a prophylactic method in prevention of preterm labor, or reduces the incidence of developing preterm labor. Although preterm labor is a multifactorial depending disease, this study indirectly supports the infectious hypothesis for the development of preterm labor (and the role of Chlamydia trachomatis in particular).