The aim of this study was to assess the potential clinical utility of interleukin-8 (IL-8) present in cervical secretions as a marker of preterm labour and delivery. Samples of cervical mucus from 91 pregnant women were assessed for the presence and concentration of IL-8. Two samples were collected (at 18 ± 2 and 28 ± 2.5 weeks of gestation) and correlated with cervicovaginal microbiology and cervical length, as measured by transvaginal ultrasound. The IL-8 concentration at 28/40 was significantly higher in women who went on to deliver preterm (p < 0.01), and there was a greater than five-fold increase from 18 to 28 weeks in 6/7 of these women.

The outcome of 71 singleton pregnancies where premature rupture of the membranes (PROM) occurred at gestations of less than 26 weeks was assessed retrospectively. The incidence of chorioamnionitis was 39.4% and the overall maternal morbidity rate was 53% but there were no long-term maternal sequelae. The latent period from PROM until delivery ranged from less than 12 hours to 77 days, with 41% of women delivering within 1 week. There was no increased risk of infection with increasing latent period. The perinatal mortality was 66.2% (26.7% stillbirths and 39.4% neonatal deaths). There was a 65% chance of a live baby if PROM occurred between 24-26 weeks but only 5 of 40 fetuses (12.5%) survived if PROM occurred before 24 weeks. The use of antibiotics, tocolytics and steroids in an uncontrolled manner is reported. Overall there is little serious risk to the mother if a conservative approach is adopted but only about one-third of such women will take home a live baby.

Transvaginal ultrasound of the cervix is increasingly used to estimate cervical length during pregnancy. Initially used to determine a possible need for cervical suture, the technique has been shown to be of value in the prediction of preterm delivery In addition, bacterial vaginosis has been shown to be associated with an increased risk of preterm delivery. We hypothesised that shortening of the cervix and potential cervical pathogens, in particular the presence of bacterial vaginosis, act synergistically in the pathogenesis of premature labour. Three hundred and sixteen women were recruited for prospective longitudinal follow-up, with both transvaginal ultrasound and cervical bacteriology performed at approximately 18 and 28 weeks gestation. A strong correlation was found between a shortened cervix and preterm delivery (p<0.02 at 18 weeks; p<0.001 at 28 weeks). Women with both a short cervix and cervical pathogens had the highest risk of preterm delivery (43%), although not significantly greater than a short cervix with normal cervical flora (31% preterm delivery). In the presence of a normal cervical length, preterm delivery rates in the presence of normal flora and potential cervical pathogens were much lower (9% and 5% respectively).