The frequency and clinical significance of intra-amniotic inflammation in patients with a positive cervical fetal fibronectin

Yoon, Bo Hyun; Romero, Roberto; Moon, Jeong Mi; Oh, Soo‐Young; Han, Soo‐Yeon; Kim, Ju Cheol; Shim, So Yeon

doi:10.1067/mob.2001.118162

Cited by 47 publications

(29 citation statements)

References 24 publications

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“…The AF IL-6 concentrations were used to assess the presence and magnitude of an inflammatory response based upon previous studies conducted by us and others [78–81,85, 90, 96, 163–172], which indicate that AF IL-6 concentrations correlate with the outcome of preterm labor [11,63, 79, 88, 173–179], preterm PROM [173, 180, 181], cervical insufficiency [182], placenta previa [89], and a short cervix [183–186]. The median AF IL-6 concentration in patients with clinical chorioamnionitis and microbial-associated intra-amniotic inflammation was 14 ng/mL, which was higher than that of patients with intra-amniotic inflammation without detectable microorganisms (4.7 ng/mL).…”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

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208

216

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Introduction The objectives of this study were: 1) to determine the amniotic fluid (AF) microbiology of patients with the diagnosis of clinical chorioamnionitis at term using both cultivation and molecular techniques; and 2) to examine the relationship between intra-amniotic inflammation with and without microorganisms and placental lesions consistent with acute AF infection. Methods The AF samples obtained by transabdominal amniocentesis from 46 women with clinical signs of chorioamnionitis at term were analyzed using cultivation techniques (for aerobic and anerobic bacteria as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation [defined as an AF interleukin 6 (IL-6) concentration ≥ 2.6ng/mL], and placental lesions consistent with acute AF infection (acute histologic chorioamnionitis and/or acute funisitis) were examined according to the results of AF cultivation and PCR/ESI-MS as well as AF IL-6 concentrations. Results 1) Culture identified bacteria in AF from 46% (21/46) of the participants, whereas PCR/ESI-MS was positive formicroorganisms in 59% (27/46) – combining these two tests, microorganisms were detected in 61% (28/46) of patients with clinical chorioamnionitis at term. Eight patients had discordant test results; one had a positive culture and negative PCR/ESI-MS result, whereas seven patients had positive PCR/ESI-MS results and negative cultures. 2) Ureaplasma urealyticum (n = 8) and Gardnerella vaginalis (n = 10) were the microorganisms most frequently identified by cultivation and PCR/ESI-MS, respectively. 3) When combining the results of AF culture, PCR/ESI-MS and AF IL-6 concentrations, 15% (7/46) of patients did not have intra-amniotic inflammation or infection, 6.5% (3/46) had only MIAC, 54% (25/46) had microbial-associated intra-amniotic inflammation, and 24% (11/46) had intra-amniotic inflammation without detectable microorganisms. 4) Placental lesions consistent with acute AF infection were significantly more frequent in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [70.8% (17/24) vs. 28.6% (2/7); P = 0.04]. Conclusion Microorganisms in the AF were identified in 61% of patients with clinical chorioamnionitis at term; 54% had microbial-associated intra-amniotic inflammation, whereas 24% had intra-amniotic inflammation without detectable microorganisms.

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Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

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208

216

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“…Cervical fibronectin levels do not seem to be a reliable marker of CA [166]. Determinations of proinflammatory cytokines seem to be the most reliable markers.…”

Section: Diagnosis and Prevention Of Camentioning

confidence: 99%

Chorioamnionitis: A Risk Factor for Fetal and Neonatal Morbidity

Bracci¹,

Buonocore²

2003

Neonatology

113

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Despite widespread use of drugs to arrest preterm labor, there has been no decrease in the numbers of low-birth-weight or preterm infants in the last 20 years. Evidence from many sources links preterm birth to symptomatic and subclinical infections. Recently, an increasing body of evidence has suggested that not only is subclinical infection responsible for preterm birth but also for many serious neonatal sequelae, including periventricular leukomalacia, cerebral palsy, respiratory distress and even bronchopulmonary dysplasia and necrotizing enterocolitis. Proxies of intrauterine infection include clinical chorioamnionitis, histological chorioamnionitis and intraamniotic increase in cytokines, which have been found to be associated with acute neonatal morbidity and mortality and, at least to some degree, with neurological impairment, chronic lung disease and thymus involution in the preterm infant. The infectious/inflammatory mechanisms involved are not fully understood, and the types of microbes and genetic features of host adaptive and innate immune responses need to be better characterized.

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“…In a smaller and more recent meta-analysis, an overall sensitivity of 52% and a specificity of 85% were reported [694]. In women with a positive cervical fFN test at 23-31 weeks, amniotic fluid cultures were positive in 1/57 cases and IL-6 was elevated in 3/57 cases [460]. The fFn test is not suitable as a screening test.…”

Section: Ffn In Asymptomatic Womenmentioning

confidence: 92%

“…Funisitis is associated with amniotic infection and inflammation, neonatal sepsis, and CP [38,459,460]. Available evidence suggests that polymorphonuclear leucocytes in amniotic fluid of women in PTL (n = 4) are of fetal origin [461].…”

Section: Funisitismentioning

confidence: 98%

Preterm Birth: A Review

Schellenberg

2006

CWHR

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Preterm birth at less than 37 weeks gestation is a substantial burden to the community, representing a major source of infant death, severe handicap, and suffering for both victims and their families. Despite considerable research, little progress has been made in its prevention, partly because preterm birth is the endpoint of a silent multifactorial syndrome which begins long before labour starts. Infectious inflammation often plays a central role, but maternal susceptibility is probably also critical. Although progestogen treatment is preventive in some women with a prior history of preterm birth this will have little impact on the overall preterm birth rate unless effective treatment can be used in a much larger population of at risk women. An accurate screening test to identify such women is needed. The discovery of a screening test and of novel treatments requires a better understanding of the underlying biomolecular events. This paper gives an overview of the physiology and molecular biology of normal and abnormal pregnancy and parturition, the causes and consequences of preterm birth, and the difficulties of predicting and preventing preterm birth.

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The frequency and clinical significance of intra-amniotic inflammation in patients with a positive cervical fetal fibronectin

Cited by 47 publications

References 24 publications

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Chorioamnionitis: A Risk Factor for Fetal and Neonatal Morbidity

Preterm Birth: A Review

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