Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes

PURPOSE: To develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model. MATERIALS AND METHODS: This retrospective cohort study included 146 consecutive women presenting with PPROM (20-33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis. RESULTS: Risk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2. CONCLUSION: For women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.

Relationship between Maternal Serum C-Reactive Protein, Funisitis and Early-Onset Neonatal Sepsis

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.

The value of the soluable intercellular adhesion molecule-1 levels in matermal serum for determination of occult chorioamnionitis in premature rupture of membranes / 华中科技大学学报（医学）（英德文版）

To compare the diagnostic value of soluble intercellular adhesion molecule 1 (sICAM-1) with that of c-reactive protein (CRP) for detecting chorioamnionitis (CAM) in serum of women with premature rupture of membranes (PROM), 55 pregnant women with PROM, including 18 pregnant women with preterm premature rupture of membranes (PPROM) and 20 normal pregnant women at term (TPROM) were studied. Maternal serum were measured by Sandwish enzyme-linked immunoabsorbent assay (ELISA) for sICAM. CAM was histologically confirmed after delivery. The results revealed that (1) maternal serum levels of sICAM-1 and CRP were significantly higher in women with PROM than those without it; (2) maternal serum levels of sICAM-1 and CRP were significantly higher in women with CAM than those without it; (3) serum levels of sICAM-1 in PPROM women were similar to those in TPROM women, whereas serum levels of CRP in PPROM women were significantly higher than those in TPROM women; (4) the sensitivity, specificity, positive predictive value, negative predictive value, Kappa index and area under receiver operating characteristic (ROC) curve of maternal serum sICAM-1 (cutoff 104.7 ng/ml) and CRP (cutoff 1.03 mg/dl) for diagnosing CAM were 100%, 91.2%, 87.5%, 100%, 0.20, 0.995 and 81.0%, 73.5%, 65.4%, 86.2%, 0.13, 0.811, respectively; (5) among the mild histological CAM group, severe histological CAM group and clinical CAM group, the difference in maternal serum levels of sICAM-1 were significantly (P<0.001), with the order of concentration from high level to low level corresponding to the severity of CAM. It is concluded that maternal serum level of ICAM-1 is superior to that of CRP as biomarker for diagnosing intraamniotic infection in pregnant women with PROM.

C-reactive proteins as an indicator of sub-clinical infection in cases of premature rupture of membranes.

The present study was conducted on 25 cases of preterm, premature rupture of membranes and 25 patients preterm with intact membranes, between 28-36 weeks of gestation, admitted in the maternity ward of Obstetrics and Gynecology, PGIMS, Rohtak. The sensitivity and specificity of CRP determination was found to be 80% each as an early predictor of subclinical chorioamnionitis. TLC had a low sensitivity of 20% and specificity of 60% in detecting histopathological chorioamnionitis. So CRP estimation is a reliable marker for detection of early choriamnionitis, at the same time, it is quite affordable and reasonably simple.

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.

Ruptura prematura de membranas. ¿Son necesarios los antibióticos? / Premature rupture of membranes. Is necessary the use antibiotics?

Se incluyeron 33 recién nacidos (RN) a término con antecedentes de ruptura prematura de membranas (RPM), hijos de madres sanas, a los que se les tomó muestras sanguíneas para biometría hemática, recuento leucocitario, relación B/N, plaquetas, y proteínas C reactiva; además se registró su sexo, Apgar al minuto y a los cinco minutos, el tiempo de ruptura, la cantidad eliminada de líquido amniótico y su evolución clínica. El Apgar al minuto fue de 8 y 9 a los 5 minutos. La RPM varió desde 12 hasta 96 horas (cuatro días) con una media de 22.4 horas. La cantidad de líquido amniótico al nacimiento fue adecuada en 29 casos, en cuatro se consideró disminuido. Los cuatro niños nacidos de estas mujeres fueron mantenidos en observación hasta obtener los resultados de exámenes. El recuento leucocitario reportó una media de 15,854, con una relación B/N que osciló de 0 a 0.125. Las plaquetas variaron entre 22,000 y 370,000 con una media de 210,393.9. La proteína C reactiva fue negativa en todos los niños, y en las evaluaciones clínicas no tuvieron signos características de infección. Los resultados concuerdan con lo informado en la literatura; muchos niños son tratados innecesariamente, por lo que es preciso documentar la infección mediante métodos sencillos. El empleo de antibióticos debe hacerse sólo en aquellos niños que se amerite

Concentraciones plasmáticas y leucocitarias de la vitamina C en la gestante / Plasma and leukocyte ascorbic acid levels during pregnancy

Antecedentes: Las recomendaciones de vitamina C para las mujeres embarazadas son resultados de extrapolaciones de estudios en mujeres no embarazadas o varones por lo que se requiere utilizar criterios funcionales para el establecimiento de recomendaciones adecuadas de consumo. Objetivo: Establecer la relación entre las concentraciones plasmáticas y leucocitarias de vitamina C a lo largo de la gestación. En el entendido de que las concentraciones de vitamina C en leucocitos se asocian con la ruptura prematura de membranas (prueba funcional). Material y Métodos: Se estudiaron prospectivamente 41 gestantes aparentemente sanas desde la semana 16 hasta la 36 de gestación. En cada evaluación se tomó una muestra sanguínea para determinar concentración de vitamina C en plasma y en leucocitos, todas las determinaciones se hicieron por duplicado y el coeficiente de variación siempre fue menor al 5 por ciento. Resultados: En la muestra observada las concentraciones de vitamina C tanto en plasma como en leucocitos se mantuvieron relativamente constantes a lo largo de la gestación, siendo estrecho. Unicamente fue posible establecer asociación entre la concentración plasmática y leucocitaria en la semana 16 de gestación (R²=54.86 p< 0.001), en el resto de las evaluaciones la correlación fue pobre o no signifiativa. Discusión: Se plantea que la falta de asociación encontrada se debe a la estrecha variación en las concentraciones tanto de plasma como de leucocitos encontradas en la población y se propone incrementar el intervalo de observación

C-reactive protein in pregnancy, labor, in the post partum period and in premature rupture of membranes

The changes in the serum level of the C-reactive protein [CRP] over the course of normal pregnancy, labor, in premature rupture of membranes [PROM] and also in the postpartum period, were evaluated in 80 cases using turbidimetric system. Also, the efficiency of CRP determination versus ESR, total leucocytic count and differential blood count in detecting PROM was evaluated. The study revealed that CRP levels did not show a significant difference in pregnancy compared with the control group. However, CRP level was more sensitive and specific than the other parameters in detecting subclinical chorioamnionitis. It has added the advantage of being an easy, accurate, rapid diagnostic method