Intra-Amniotic Infection/Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor

Abstract

The aim of this study was to determine whether intra-amniotic infection/inflammation (IAI) was associated with subsequent ruptured membranes in women with preterm labor and intact membranes who had a clinically indicated amniocentesis. This retrospective cohort study included 237 consecutive women with preterm labor (20-34.6 weeks) who underwent amniocentesis. The clinical and laboratory parameters evaluated included demographic variables, gestational age, C-reactive protein (CRP) and amniotic fluid (AF) white blood cell, interleukin-6 (IL-6) and culture results. IAI was defined as a positive AF culture and/or an elevated AF IL-6 level (>2.6 ng/mL). The primary outcome was ruptured membranes in the absence of active labor occurring within 48 hours of amniocentesis. Preterm premature rupture of membranes subsequently developed in 10 (4.2%) women within 48 hr of amniocentesis. Multivariate analysis demonstrated that only IAI was independently associated with the ruptured membranes occurring within 48 hr of amniocentesis. In the predictive model based on variables assessed before amniocentesis, only CRP level was retained. IAI is an independent risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. Prior to amniocentesis, measurement of serum CRP level can provide a risk assessment for the subsequent development of ruptured membranes after the procedure.

Vaginal Lactoferrin Modulates PGE2, MMP-9, MMP-2, and TIMP-1 Amniotic Fluid Concentrations

“…In particular, sterile IAI can be a preexisting condition or can be either triggered or aggravated by invasive diagnostic procedures such as amniocentesis. Consistently, a recent study [6] suggested that preexisting infection/inflammation may be related to the rupture of membranes following amniocentesis, with the procedure itself possibly contributing to the multifactorial etiology of PPROM. Thus, control of inflammation is essential in order to prevent the risks associated with amniocentesis and other invasive procedures.…”

“…Although the aforementioned complications might have a multifactorial etiology [3], a growing body of evidence suggests that intra-amniotic inflammation and infection, together with invasive diagnostic procedures, such as amniocentesis, may be important factors involved in the onset of pregnancy complications [2, 4, 5]. In this regard, it has recently been observed that a preexisting inflammatory state might predispose pregnant women undergoing amniocentesis to premature rupture of membranes within 48 hours from the procedure [6]. Furthermore, a higher AF concentration of IL-6 had already been reported in women with spontaneous abortion following amniocentesis [7].…”

Prediction of spontaneous preterm birth in women with cervical insufficiency: Comprehensive analysis of multiple proteins in amniotic fluid

“…Abdominal amniocentesis was performed under ultrasound guidance after informed consent was obtained from the patient, and AF was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasma ( Ureaplasma urealyticum and Mycoplasma hominis ) and analyzed for white blood cell (WBC) count, according to methods previously described . The remaining AF was centrifuged and stored at −70°C until assayed.…”

Inflammatory Proteins in the Amniotic Fluid, Plasma, and Cervicovaginal Fluid for the Prediction of Intra-Amniotic Infection/Inflammation and Imminent Preterm Birth in Preterm Labor

“…Following our hospital protocol and previously described methods, the serum C-reactive protein (CRP) levels were measured in all participants at the time of amniocentesis. 18 Medications, such as antibiotics, tocolytics, or corticosteroids, were commenced after sampling.…”