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

Park, Kyo Hoon; Kim, Shi Nae; Oh, Kyung Joon; Lee, Sung Youn; Jeong, Eun-Hee; Ryu, Aeli

doi:10.1177/1933719111432869

Cited by 44 publications

(72 citation statements)

References 36 publications

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“…In regard to HCA and MIAC in women who delivered preterm neonates, the prevalence, inverse correlation with gestational age at presentation and birth, and the relationship with adverse outcome are in line with the observations previously reported by our group and other groups [6, 7, 10, 12, 15]. Moreover, in the present study, the frequency of HCA with negative AF culture was 23%, also in keeping with the findings previously reported by Yoon et al and our group [7, 10].…”

Section: Discussionsupporting

confidence: 91%

“…Early-onset neonatal sepsis, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) of grade II or higher, periventricular leukomalacia (PVL), and necrotizing enterocolitis (NEC) were diagnosed according to the definitions previously described in detail. [15] Composite morbidity was defined as the presence of any of these complications.…”

Section: Methodsmentioning

confidence: 99%

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Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Park

Jung

2017

PLoS ONE

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ObjectiveTo evaluate the effect of histological chorioamnionitis (HCA) with a negative amniotic fluid (AF) culture on adverse pregnancy and neonatal outcomes and inflammatory status in the AF compartment in women with preterm labor or preterm premature rupture of membranes (PPROM).MethodsThis is a retrospective cohort study of 153 women diagnosed as having a preterm labor or PPROM (20–34 weeks) who delivered singleton gestations within 48 hours of amniocentesis. AF obtained through amniocentesis was cultured, and interleukin (IL)-6, IL-8, and metalloproteinase-9 (MMP-9) levels were determined. The placentas were examined histologically.ResultsThe prevalence of HCA with negative AF culture was 23.5% (36/153). The women with HCA but with a negative AF culture (group 2) and those with a positive AF culture (group 3) had a significantly lower mean gestational age at amniocentesis and delivery than those with a negative AF culture and without HCA (group 1). Women in group 3 had the highest levels of AF IL-6, IL-8, and MMP-9, followed by those in group 2, and those in group 1. Composite neonatal morbidity was significantly higher in groups 2 and 3 than in group 1, but this was no longer significant after adjusting for confounders caused mainly by the impact of gestational age.DiscussionIn the women who delivered preterm neonates, HCA with a negative AF culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, and prematurity-associated composite neonatal morbidity, and its risks are similar to the risk posed by positive AF culture.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Park

Jung

2017

PLoS ONE

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“…It is also established that IL-6 is the main trigger of the synthesis of C-reactive protein (CRP) (11). Therefore, not only the number of mother's white blood cells (WBC) but also the analysis of CRP in blood serum may indicate existing infection after PPROM (12). It is deemed that increased concentration of CRP in blood serum is one of the most accurate markers for early-onset neonatal infection prognosis.…”

Section: Introductionmentioning

confidence: 99%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother's blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns.Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)-34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups.Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25 ± 22.14 mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005).Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

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“…Elevated maternal plasma concentrations of inflammatory cytokines in preterm gestations complicated by PTL or pPROM are associated with an increased risk of intra-amniotic infection [22, 24, 34, 41, 62, 63, 68, 125, 126, 141, 143, 198]. The findings herein demonstrate that MIAC is associated with decreased maternal plasma concentrations of soluble α-klotho.…”

Section: Commentsmentioning

confidence: 57%

“…The presence of MIAC is associated with increased risk of adverse perinatal outcomes, such as early preterm birth[164, 165, 171, 177, 202, 207], neonatal sepsis[104, 167], bronchopulmonary dysplasia[48, 206], neonatal white matter brain lesions[203, 210], and cerebral palsy[13, 14, 176, 205, 209]. Although MIAC is considered to be confined to the amniotic cavity and not a systemic condition, studies with flow cytometry have shown phenotypic and metabolic changes in leukocytes[45, 46] as well as changes in maternal cytokines concentration [22, 24, 34, 41, 62, 63, 68, 125, 126, 141, 143, 198]. These observations suggest that biomarkers for MIAC may be found in the maternal circulation.…”

Section: Introductionmentioning

confidence: 99%

Infection and smoking are associated with decreased plasma concentration of the anti-aging protein, α-klotho^a

Lam-Rachlin¹,

Romero

Korzeniewski³

et al. 2013

Journal of Perinatal Medicine

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Objective The objective of this study was to determine whether maternal plasma concentrations of soluble α-klotho are different between women with microbial invasion of the intra-amniotic cavity (MIAC) and those without MIAC among preterm labor and intact membranes (PTL) or preterm prelabor rupture of membranes (pPROM). Methods A cross-sectional study was conducted to include women in the following groups:1) PTL with MIAC (n=14); 2) PTL without MIAC (n=79); 3) pPROM with MIAC (n=30); and 4) pPROM without MIAC (n=33). MIAC was defined as a positive amniotic fluid culture for microorganisms (aerobic/anaerobic bacteria or genital mycoplasmas). Amniotic fluid samples were obtained within 48 hours from maternal blood collection. Plasma concentration of soluble α-klotho was determined by ELISA. Results 1) The median plasma concentration (pg/mL) of soluble α-klotho was significantly lower in patients with MIAC than in those without MIAC (787.0 vs. 1117.8; p <0.001); 2) Among patients with PTL, those with MIAC had a lower median plasma concentration (pg/mL) of soluble α-klotho than those without MIAC (787.0 vs. 1138.9; p=0.007); 3) Among patients with pPROM, those with MIAC had a lower median plasma concentration (pg/mL) of soluble α-klotho than those without MIAC (766.4 vs. 1001.6; p=0.045); 4) There was no significant difference in the median plasma concentration of soluble α-klotho between PPROM without MIAC and PTL without MIAC (1001.6 pg/mL vs. 1138.9 pg/mL, respectively; p=0.5); 5) After adjustment for potential confounders (maternal age, tobacco use, gestational age at venipuncture), soluble α-klotho remained significantly associated with MIAC (p= 0.02); and 6) Among patients without MIAC, smoking was significantly associated with a lower median plasma concentration soluble α-klotho than in non-smokers (794.2 pg/mL vs. 1382.0 pg/mL, respectively; p<0.001); however, this difference was not observed in patients with MIAC. Conclusions Intra-amniotic infection occurring at preterm gestations (regardless of membrane status) was associated with a decrease in maternal plasma concentrations of soluble α-klotho. Moreover, among patients without infection, the plasma concentration of soluble α-klotho was lower in smokers.

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

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

Cited by 44 publications

References 36 publications

Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Infection and smoking are associated with decreased plasma concentration of the anti-aging protein, α-klotho^a

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

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

Cited by 44 publications

References 36 publications

Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Infection and smoking are associated with decreased plasma concentration of the anti-aging protein, α-klothoa

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Infection and smoking are associated with decreased plasma concentration of the anti-aging protein, α-klotho^a