OBJECTIVE: Intrauterine Pressure Catheters (IUPC) are thought to create a pathway for contamination and ascending infections. We sought to estimate the risk of chorioamnionitis associated with IUPC use in term labor. STUDY DESIGN: This is a retrospective cohort study of term (37 weeks), singleton pregnancies who labored at our tertiary care center from 2005 to 2018. The primary outcome of chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39 C or 38e38.9 C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the presence of an IUPC documented in the medical record. Cox proportional hazard regression was used to model the effect of cervical examinations on the risk of chorioamnionitis while adjusting for adjusted for number of cervical exams, epidural use, meconium, smoking, GBS, parity, BMI, duration of rupture, labor induction and cesarean section. RESULTS: 20,579 women met inclusion criteria and1,039 (5%) women were diagnosed with chorioamnionitis. Of the subjects diagnosed with chorioamnionitis, 185 (17.8%) had IUPCs compared to 22.5% in women not diagnosed with infection (p<0.001). IUPCs were not associated with increased rate of chorioamnionitis after adjusting for potential confounders (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.5-0.7; p¼<0.001). Presence of IUPCs was higher in women undergoing unplanned cesarean delivery (30.6% versus 21.1% in women undergoing vaginal delivery, p¼<0.001). Meconium rates were not higher in women with IUPCs (IUPC 20.0% versus no IUPC18.8 p¼0.06) CONCLUSION: In contrast to prior work, routine use of internal monitoring in laboring patient did not increase the risk of chorioamnionitis. Internal monitors should not be avoided during term labor management.
Preeclampsia (PE) is a major cause of maternal and neonatal morbidity and mortality. Current methods for evaluation of patients with suspected PE do not reliably predict which patients will later develop PE nor distinguish between PE with and without severe features. The objective of this study was to identify candidate extracellular miRNA (ex-miRNA) biomarkers for early diagnosis and prognosis of PE in a cohort of subjects presenting for evaluation of suspected PE. Small RNA-seq libraries were created from maternal serum samples, prospectively collected from participants undergoing evaluation for suspected PE between 20-40 weeks gestational age. Measurements for bivariate biomarkers, consisting of ratios of pairs of ex-miRNAs were performed. 110 bivariate ex-miRNA biomarkers passed both discovery (48 cases, 34 controls) and verification (23 cases, 18 controls) criteria. Specific biomarkers differed in their patterns of expression among different categories of hypertensive disorders in pregnancy (HDP). An iterative machine learning method was then used to identify 3 bivariate miRNA biomarkers that, when applied serially, differentiated cases from controls with a sensitivity of 93% and a positive predictive value (PPV) of 55%, and additionally distinguished between PE cases of different severity. In an independent validation cohort of 11 cases and 7 controls, these three biomarkers had a sensitivity of 91% and a PPV of 85%. We have discovered, verified, and validated 3 bivariate ex-miRNA biomarkers, which, when applied serially, enable accurate early diagnosis of preeclampsia. Bivariate ex-miRNA biomarkers can distinguish between different subtypes of HDP.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.