The presence of amniotic fluid leukoattractants accurately identifies histologic chorioamnionitis and predicts tocolytic efficacy in patients with idiopathic preterm labor

Cherouny, Peter H.; Pankuch, Glenn A.; Botti, John J.; Appelbaum, Peter C.

doi:10.1016/s0002-9378(11)91571-3

Cited by 25 publications

(6 citation statements)

References 15 publications

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“…In fact evaluation of IL-6 [2,3] , IL-8 [4,5] , LE [6,7], and glucose [9,10] in the amniotic fl uid has previously been reported. In the present study, the 4 patients, who developed abortion, showed signifi cantly elevated concentrations of cytokines in their amniotic fl uid, while the concentrations of glucose were decreased.…”

Section: Discussionmentioning

confidence: 95%

“…Intrauterine infection in the early second trimester is critical for fetus survival (and in rare cases, for the mother, due to septic shock) and thus many methods have been developed for its detection. In many cases, amniotic infection is in fact diagnosed not by detection of microorganisms but by evaluation of amniotic infl ammatory substances, such as interleukin (IL)-6 [2,3] , IL-8 [4,5], and leukocyte elastase (LE) [6,7] , or through fi ndings of white blood cells (WBC) [8] in amniotic fl uid obtained from patients in preterm labor. Furthermore, decrease in the amniotic glucose concentration has been proposed as a convenient marker of infectious amnion [9,10] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation Levels of Cytokines in Amniotic Fluid of Women with Intrauterine Infection in the Early Second Trimester

Suzuki¹,

Yamamoto²,

Kojima³

et al. 2005

Fetal Diagn Ther

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Amniotic fluid was obtained from 180 patients by amniocentesis at 16–22 weeks of gestation and assayed for the levels of interleukin (IL)-6, IL-8, leukocyte elastase (LE), and glucose. Ten of cases had clinical symptoms, such as uterine contraction, genital bleeding, and cervical ripening, and the other 170 were assessed for fetal chromosomal features. Four of the ten cases with uterine contraction developed abortion, while 10 of those screened had findings of fetal chromosomal anomalies, and 7 cases then underwent induced abortion artificially. In the cases of abortion, levels of IL-6, IL-8 and LE were higher than in the samples from the 160 pregnant women without clinical symptoms and a normal karyotype, while glucose in amniotic fluid was lower. Of 6 cases with clinical symptoms, but not developing abortion, 4 developed preterm labor, and in these IL-6 and IL-8 also were significantly elevated, with LE being slight high compared to normal. The results suggest that IL-6, IL-8, LE, and glucose in amniotic fluid at early second trimester can be used as markers of severe infection in the uterus, and with the first two being particularly sensitive.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Evaluation Levels of Cytokines in Amniotic Fluid of Women with Intrauterine Infection in the Early Second Trimester

Suzuki¹,

Yamamoto²,

Kojima³

et al. 2005

Fetal Diagn Ther

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“…One explanation could be empirical; the more tissue locations sampled, the greater the likelihood of finding a locus with a high number of polymorphonuclear leukocytes/high-powered field. However, these results highlight the challenges of comparing HCA results across studies that include only extraplacental membranes (23,41,43,48), only disc (24,25,38,40,53), or both (26,34,36,46).…”

Section: Discussionmentioning

confidence: 96%

“…Most studies can be grouped into one of two categories: those that have used inflammatory cell thresholds (i.e., polymorphonuclear leukocytes/high-powered field) (24,38,(43)(44)(45)(46)(47)(48) and those that have incorporated a complex HCA grading and/or staging approach (49)(50)(51). Within the first category, HCA criteria have varied with respect to 1) the tissue components included, for example, placental disc, extraplacental membranes, and cord (33,42,47,52), disc only (24,25,38,40,53), or extraplacental membranes only (41,43,44,48); 2) threshold, for example, ''any inflammation'' (25,33,34,42,52,53), greater than five polymorphonuclear leukocytes/ high-powered field (24,38,47), and greater than 10 polymorphonuclear leukocytes/high-powered field (43,45,46,48); and 3) number of high-powered fields that must exceed the threshold (43,46,48). In the second category, the detailed systems of staging/grading have also varied.…”

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confidence: 99%

Histologic Chorioamnionitis and Preterm Delivery

Holzman

Lin

Senagore

et al. 2007

American Journal of Epidemiology

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Inconsistent findings linking placental histologic chorioamnionitis (HCA) and preterm delivery may result from variations in HCA definition, population studied, and exclusion criteria. This analysis from the 1998-2004 Pregnancy Outcomes and Community Health Study (five Michigan communities) includes the first 1,053 subcohort women (239 preterm, 814 term) with completed placental assessments. Multiple HCA definitions were constructed by 1) varying polymorphonuclear leukocytes/high-powered field thresholds and placenta components included and 2) using polymorphonuclear leukocyte characteristics to assign low/high maternal, fetal inflammation stage and grade. In African Americans, HCA was associated with preterm delivery before 35 weeks. The effect size was modest for polymorphonuclear leukocytes/high-powered field thresholds of greater than 10 and greater than 30 (odds ratios (ORs) ¼ 0.8 and 2.0); larger for greater than 100 (OR ¼ 3.2, 95% confidence interval (CI): 1.4, 7.1); strengthened after excluding medically indicated preterm deliveries (OR ¼ 4.9, 95% CI: 2.0, 11.8); and strongest for high maternal/high fetal HCA (OR ¼ 5.6, 95% CI: 1.4, 22.1). These latter HCA criteria also produced the largest effect size in Whites/others (OR ¼ 2.7, 95% CI: 0.3, 26.9). Among preterm deliveries before 35 weeks excluding those medically indicated, 12% of Whites/others and 55% of African Americans had high maternal HCA. The authors conclude that HCA definition, exclusion criteria, and race/ethnicity influence the HCA-preterm delivery association and that HCA contributes to preterm delivery-related ethnic disparity.

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“…In addition, the bacteria isolated by Goldstein et al 4 from second-trimester AF were generally different from those cultured in reported studies on AF from patients in preterm labor with intact membranes. 1,3 A closer evaluation of the report by Goldstein et al. 4 reveals that 5 …”

mentioning

confidence: 95%

Occult Intraamniotic Infection at the Time of Midtrimester Genetic Amniocentesis:A Reassessment

Cherouny

Pankuch

Botti

1994

Infectious Diseases in Obstetrics and Gynecology

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Objective: The objective of this study was to reevaluate the incidence of occult early midtrimester intraamniotic infection in asymptomatic patients at the time of genetic amniocentesis.Methods: A total of 177 amniotic fluid (AF) specimens from patients referred for genetic amniocentesis between 15 and 20 postmenstrual weeks were evaluated for the presence of bacteria by detailed light microscopy, after Gram and Wright stain, and by cultures for aerobic and anaerobic baceria, Mycoplasma sp., and Ureaplasma urealyticum. Seventy-seven AF specimens were also tested for the presence of bioactive leukoattractants by a leukotaxis bioassay.Results: All fluids were negative for bacteria and bioactive leukoattractants [95% confidence interval (CI), 0-1.9%; 99% CI, 0-2.9%]. This is significantly less than a recently reported incidence of 5.09% (P 0.002). Incidentally, artifacts with light microscopic morphology consistent with spermatozoa were found during the detailed light microscopic evaluation of AF Gram stains from 2 (1.1%) AF samples in otherwise uneventful pregnancies, a previously unreported finding. Scanning electron microscopy was used to confirm the light microscopic findings.Conclusions

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The presence of amniotic fluid leukoattractants accurately identifies histologic chorioamnionitis and predicts tocolytic efficacy in patients with idiopathic preterm labor

Cited by 25 publications

References 15 publications

Evaluation Levels of Cytokines in Amniotic Fluid of Women with Intrauterine Infection in the Early Second Trimester

Evaluation Levels of Cytokines in Amniotic Fluid of Women with Intrauterine Infection in the Early Second Trimester

Histologic Chorioamnionitis and Preterm Delivery

Occult Intraamniotic Infection at the Time of Midtrimester Genetic Amniocentesis:A Reassessment

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