A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes

Lee, Seung Mi; Romero, Roberto; Park, Joong Shin; Chaemsaithong, Piya; Jun, Jong Kwan; Yoon, Bo Hyun

doi:10.1515/jpm-2014-0276

Cited by 17 publications

(11 citation statements)

References 97 publications

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“…Amniotic fluid analysis, including rapid tests for the detection of inflammation [95–98] and molecular microbiologic methods [34, 45, 72, 81–87, 99–107], are likely to become important in the management of preterm clinical chorioamnionitis. Recent observations suggest that assessment of AF retrieved using an AF collector [65] and the measurement of inflammatory mediators could be of value in the assessment of patients with preterm PROM [108]. …”

Section: Discussionmentioning

confidence: 99%

“…Future studies are required to determine the mechanisms of disease that mimic the clinical syndrome of chorioamnionitis. Also, examination of AF retrieved by a transvaginal collector [65] in patients with preterm PROM and the determination of inflammatory cytokines may dramatically improve the accuracy of the diagnosis of “true” intra-amniotic inflammation without resorting to an invasive procedure.…”

Section: Commentmentioning

confidence: 99%

“…Recently, a device was developed for the retrieval of AF in patients with preterm PROM [65]. The assay of such fluid for inflammatory markers may help in the identification of patients with true intra-amniotic inflammation [109–111].…”

Section: Research Implicationsmentioning

confidence: 99%

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Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Kim

Hong

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Recent studies on clinical chorioamnionitis at term suggest that some patients with this diagnosis have neither intra-amniotic infection nor intra-amniotic inflammation. A false-positive diagnosis of clinical chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. Objective To determine the frequency of intra-amniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical chorioamnionitis. Study design Amniocentesis was performed in singleton pregnant women with preterm clinical chorioamnionitis (<36 weeks of gestation). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 concentration. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture; intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration of >23 ng/mL. Non-parametric and survival techniques were used for analysis. Results Among patients with preterm clinical chorioamnionitis, 24% (12/50) had microbiologic evidence of neither intra-amniotic infection nor intra-amniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intra-amniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intra-amniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. Conclusion Among patients with preterm clinical chorioamnionitis, 24% had no evidence of either intra-amniotic infection or intra-amniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a re-examination of the criteria used to diagnose preterm clinical chorioamnionitis.

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Section: Discussionmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Kim

Hong

et al. 2017

American Journal of Obstetrics and Gynecology

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“…We propose that the analysis of the AF obtained using a transcervical AF collector may facilitate the rapid diagnosis of patients with intra-amniotic inflammation from those who do not have an inflammatory process (136). Further studies are required to determine if such an approach may reduce the utilization of antibiotics in both patients in labor and in the neonatal period.…”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection?

Romero

Chaemsaithong

Korzeniewski

et al. 2015

Journal of Perinatal Medicine

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Objective The diagnosis of clinical chorioamnionitis is based on a combination of signs [fever, maternal or fetal tachycardia, foul-smelling amniotic fluid (AF), uterine tenderness, and maternal leukocytosis]. Bacterial infections within the amniotic cavity are considered the most frequent cause of clinical chorioamnionitis and an indication for antibiotic administration to reduce maternal and neonatal morbidity. Recent studies show that only 54% of patients with the diagnosis of clinical chorioamnionitis at term have bacteria in the AF and evidence of intra-amniotic inflammation. The objective of this study was to examine the performance of the clinical criteria for the diagnosis of chorioamnionitis to identify patients with microbial-associated intra-amniotic inflammation (also termed intra-amniotic infection). Materials and methods This retrospective cross-sectional study included 45 patients with the diagnosis of clinical chorioamnionitis at term, whose AF underwent analysis for: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad primers] and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay. The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of each clinical sign and their combination to identify clinical chorioamnionitis were determined using microbial-associated intra-amniotic inflammation [presence of microorganisms in the AF using cultivation or molecular techniques and elevated AF IL-6 concentrations (≥2.6 ng/mL)] as the gold standard. Results The accuracy of each clinical sign for the identification of microbial-associated intra-amniotic inflammation (intra-amniotic infection) ranged between 46.7% and 57.8%. The combination of fever with three or more clinical criteria did not substantially improve diagnostic accuracy. Conclusion In the presence of a fever during labor at term, signs used to diagnose clinical chorioamnionitis do not accurately identify the patient with proven intra-amniotic infection (i.e., those with microorganisms detected by culture or molecular microbiologic techniques and an associated intra-amniotic inflammatory response).

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“…Lee et al described a transcervical amniotic fluid collector for the assessment of amniotic fluid in PPROM patients [79]. Paired amniotic fluid (AF) samples were collected in patients with PROM by transabdominal amniocentesis and with the transcervical AF collector (Yoon's AF Collector™), which was developed and patented by the authors (patent number: Korea 10-1170053-0000).…”

Section: Amniotic Fluid Sampling From Vaginal Secretionsmentioning

confidence: 99%

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

187

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes

Cited by 17 publications

References 97 publications

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection?

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

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