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Noninvasive Prediction of Intra-Amniotic Infection and/or Inflammation in Preterm Premature Rupture of Membranes

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Abstract

Objective

To develop a model based on noninvasive parameters to predict the probability of intra-amniotic infection and/or inflammation (IAI) in women with preterm premature rupture of membranes (PPROMs).

Methods

Maternal blood was collected for determination of the C-reactive protein (CRP) level and white blood cell (WBC) count immediately after amniocentesis in 171 consecutive women with PPROMs. Intra-amniotic infection and/or inflammation was defined as a positive amniotic fluid (AF) culture and/or an elevated AF interleukin 6 level (≥2.6 ng/mL).

Results

A risk score based on a model including maternal blood CRP, WBC, parity, and gestational age was calculated for each patient. The model was shown to have an adequate goodness of fit (P = .516), and the area under the receiver–operating characteristic curve was 0.848, indicating very good discrimination.

Conclusion

The noninvasive model based on maternal blood CRP, WBC, parity, and gestational age is highly predictive of IAI in women with PPROMs.

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References

  1. Shim SS, Romero R, Hong JS, et al. Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 2004;191(4):1339–1345.

    Article  Google Scholar 

  2. Tsatsaris V, Carbonne B, Cabrol D. Place of amniocentesis in the assessment of preterm labour. Eur J Obstet Gynecol Reprod Biol. 2000;93(1):19–25.

    Article  CAS  Google Scholar 

  3. Yoon BH, Jun JK, Park KH, Syn HC, Gomez R, Romero R. Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes. Obstet Gynecol. 1996;88(6):1034–1040.

    Article  CAS  Google Scholar 

  4. van de Laar R, van der Ham DP, Oei SG, Willekes C, Weiner CP, Mol BW. Accuracy of C-reactive protein determination in predicting chorioamnionitis and neonatal infection in pregnant women with premature rupture of membranes: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):124–129.

    Article  CAS  Google Scholar 

  5. Gabriel R, Morille C, Drieux L, Bige V, Leymarie F, Quereux C. Prediction of the latency period by cervical ultrasonography in premature rupture of the membranes before term. Gynecol Obstet Fertil. 2002;30(11):856–861.

    Article  CAS  Google Scholar 

  6. Watts DH, Krohn MA, Hillier SL, Wener MH, Kiviat NB, Eschenbach DA. Characteristics of women in preterm labor associated with elevated C-reactive protein levels. Obstet Gynecol. 1993;82(4 pt 1):509–514.

    PubMed  CAS  Google Scholar 

  7. Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors for intra-amniotic infection. Obstet Gynecol. 1989; 73(4):571–575.

    PubMed  CAS  Google Scholar 

  8. Lee SE, Romero R, Lee SM, Yoon BH. Amniotic fluid volume in intra-amniotic inflammation with and without culture-proven amniotic fluid infection in preterm premature rupture of membranes. J Perinat Med. 2010;38(1):39–44.

    Article  CAS  Google Scholar 

  9. Jung HJ, Park KH, Kim SN, et al. Non-invasive prediction of intra-amniotic inflammation in women with preterm labor. Ultrasound Obstet Gynecol. 2011;37(1):82–87.

    Article  CAS  Google Scholar 

  10. Yoon BH, Romero R, Kim CJ, et al. Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity. Am J Obstet Gynecol. 1995;172(3):960–970.

    Article  CAS  Google Scholar 

  11. Harirah H, Donia SE, Hsu CD. Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intraamniotic infection. Obstet Gynecol. 2002;99(1):80–84.

    PubMed  CAS  Google Scholar 

  12. Jacobsson B, Mattsby-Baltzer I, Andersch B, et al. Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand. 2003;82(5):423–431.

    Article  Google Scholar 

  13. Gibbs RS, Blanco JD, St Clair PJ, Castaneda YS. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis. 1982;145(1):1–8.

    Article  CAS  Google Scholar 

  14. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723–1729.

    Article  CAS  Google Scholar 

  15. Dulay AT, Buhimschi IA, Zhao G, et al. Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis. Am J Obstet Gynecol. 2008;198(4):426. e421–e429.

    Article  CAS  Google Scholar 

  16. Yoon BH, Jun JK, Romero R, et al. Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha), neonatal brain white matter lesions, and cerebral palsy. Am J Obstet Gynecol. 1997;177(1):19–26.

    Article  CAS  Google Scholar 

  17. Richter D, Bartmann P, Pohlandt F. Prevention of necrotizing enterocolitis in extremely low birth weight infants by IgG feeding? Eur J Pediatr. 1998;157(11):924–925.

    Article  CAS  Google Scholar 

  18. Sauerbrei W, Royston P, Bojar H, Schmoor C, Schumacher M. Modelling the effects of standard prognostic factors in node-positive breast cancer. German Breast Cancer Study Group (GBSG). Br J Cancer. 1999;79(11–12):1752–1760.

    Article  CAS  Google Scholar 

  19. Grunkemeier GL, Jin R. Receiver operating characteristic curve analysis of clinical risk models. Ann Thorac Surg. 2001;72(2): 323–326.

    Article  CAS  Google Scholar 

  20. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148(3):839–843.

    Article  CAS  Google Scholar 

  21. Krupp NL, Weinstein G, Chalian A, Berlin JA, Wolf P, Weber RS. Validation of a transfusion prediction model in head and neck cancer surgery. Arch Otolaryngol Head Neck Surg. 2003;129(12): 1297–1302.

    Article  Google Scholar 

  22. Palacio M, Cobo T, Bosch J, et al. Cervical length and gestational age at admission as predictors of intra-amniotic inflammation in preterm labor with intact membranes. Ultrasound Obstet Gynecol. 2009;34(4):441–447.

    Article  CAS  Google Scholar 

  23. Kayem G, Maillard F, Schmitz T, et al. Prediction of clinical infection in women with preterm labour with intact membranes: a score based on ultrasonographic, clinical and biological markers. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):36–40.

    Article  Google Scholar 

  24. Yoon BH, Romero R, Moon JB, et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2001;185(5):1130–1136.

    Article  CAS  Google Scholar 

  25. Locatelli A, Ghidini A, Paterlini G, et al. Gestational age at preterm premature rupture of membranes: a risk factor for neonatal white matter damage. Am J Obstet Gynecol. 2005;193(3 pt 2):947–951.

    Article  Google Scholar 

  26. Storme L, Rakza T, Houfflin-Debarge V, et al. Consequences of premature rupture of the membranes in the perinatal lung. Arch Pediatr. 2007;14(suppl 1):S42–S48.

    Article  Google Scholar 

  27. Kiefer DG, Keeler SM, Rust OA, Wayock CP, Vintzileos AM, Hanna N. Is midtrimester short cervix a sign of intraamniotic inflammation? Am J Obstet Gynecol. 2009;200(4):374. e371–e375.

    Article  Google Scholar 

  28. Vaisbuch E, Hassan SS, Mazaki-Tovi S, et al. Patients with an asymptomatic short cervix (<or = 15 mm) have a high rate of sub-clinical intraamniotic inflammation: implications for patient counseling. Am J Obstet Gynecol. 2010;202(5):433. e431–e438.

    Article  Google Scholar 

  29. Heath VC, Southall TR, Souka AP, Novakov A, Nicolaides KH. Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history. Ultrasound Obstet Gynecol. 1998;12(5):304–311.

    Article  CAS  Google Scholar 

  30. Toth M, Witkin SS, Ledger W, Thaler H. The role of infection in the etiology of preterm birth. Obstet Gynecol. 1988;71(5): 723–726.

    PubMed  CAS  Google Scholar 

  31. Jossens MO, Eskenazi B, Schachter J, Sweet RL. Risk factors for pelvic inflammatory disease. A case control study. Sex Transm Dis. 1996;23(3):239–247.

    Article  CAS  Google Scholar 

  32. Castell JV, Gomez-Lechon MJ, David M, Fabra R, Trullenque R, Heinrich PC. Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology. 1990;12(5):1179–1186.

    Article  CAS  Google Scholar 

  33. Murtha AP, Greig PC, Jimmerson CE, Roitman-Johnson B, Allen J, Herbert WN. Maternal serum interleukin-6 concentrations in patients with preterm premature rupture of membranes and evidence of infection. Am J Obstet Gynecol. 1996;175(4 pt 1): 966–969.

    Article  CAS  Google Scholar 

  34. Pettker CM, Buhimschi IA, Magloire LK, Sfakianaki AK, Hamar BD, Buhimschi CS. Value of placental microbial evaluation in diagnosing intra-amniotic infection. Obstet Gynecol. 2007; 109(3):739–749.

    Article  Google Scholar 

  35. Jun JK, Yoon BH, Romero R, et al. Interleukin 6 determinations in cervical fluid have diagnostic and prognostic value in preterm premature rupture of membranes. Am J Obstet Gynecol. 2000; 183(4):868–873.

    Article  CAS  Google Scholar 

  36. Spong CY, Ghidini A, Ossandon M, Walker CN, Pezzullo JC. Are the cytokines interleukin-6 and angiogenin stable in frozen amniotic fluid? Am J Obstet Gynecol. 1998;178(4):783–786.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Kyo Hoon Park MD, PhD, Shi Nae Kim MD, Kyung Joon Oh MD, Sung Youn Lee MD, Eun Ha Jeong MD & Aeli Ryu MD

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  1. Kyo Hoon Park MD, PhD
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  2. Shi Nae Kim MD
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Correspondence to Kyo Hoon Park MD, PhD.

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Park, K.H., Kim, S.N., Oh, K.J. et al. Noninvasive Prediction of Intra-Amniotic Infection and/or Inflammation in Preterm Premature Rupture of Membranes. Reprod. Sci. 19, 658–665 (2012). https://doi.org/10.1177/1933719111432869

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