Variación del perímetro cefálico en prematuros menores de 34 semanas expuestos a corioamnionitis histológica / Variation of head circumference variation in preterm infants less than 34 weeks to histologic chorioamnionitis

RESUMEN Objetivo : Analizar las variaciones del perímetro cefálico (PC) en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH), y observados hasta los 2 años de edad corregida. Material y métodos : Estudio de cohorte secundaria de dos estudios prospectivos. Los datos correspondieron a mediciones del PC al nacimiento, a las 40 semanas y a los 2 años de edad corregida. La variación del PC se analizó en los prematuros con y sin exposición a CAH. La CAH se analizó de acuerdo con los subtipos subcorionitis/corionitis, corioamnionitis y corioamnionitis más funisitis. Resultados : De 91 prematuros incluidos, el 41,8 % (38/91) tuvo CAH. El promedio del PC al nacimiento fue de 27,7 cm (percentil 31,2) en los expuestos y de 28,3 cm (percentil 42,1) en los no expuestos (p = 0,039); a las 40 semanas y a los 2 años, los promedios fueron similares. El subtipo corioamnionitis estuvo asociado con un menor PC (p < 0,05). La menor edad gestacional al nacer (p < 0,005) se relacionó con una mayor velocidad de crecimiento craneal. La CAH y el retardo de crecimiento intrauterino (RCIU) fueron los factores determinantes del menor PC en las tres edades evaluadas, y la sepsis confirmada solo tuvo lugar a las 40 semanas. Conclusiones : Los prematuros menores de 34 semanas expuestos a la CAH tuvieron menor percentil de PC al nacimiento; se observó recuperación del percentil de PC a las 40 semanas; y, finalmente, el subtipo corioamnionitis se relacionó con un menor PC a los 2 años de edad corregida. El factor RCIU potencia esta asociación en las tres edades y la sepsis solo a las 40 semanas. Se recomienda realizar futuros estudios para confirmar estos hallazgos.

SUMMARY Objective : To analyze the variations of head circumference (HC) in preterm infants, born with less than 34 weeks of gestation, exposed to histologic chorioamnionitis (CAH), and observed until 2 years of corrected age. Materials and methods : This is a cohort study derived from two prospective studies. The analyzed data corresponded to HC measures obtained from the subjects at three points: birth, 40 weeks, and 2 years of corrected age. The subjects were classified in two groups: exposed and not exposed to CAH. Preterm infants with CAH were divided according to its subtype in chorioamnionitis, subchorionitis and chorioamnionitis plus funisitis. Results : Out of 91 preterm infants included in the study. 41.8% (38/91) presented CAH. At birth, the average measure of HC in exposed infants was 27.7 cm (31,2 percentile), while in not exposed infants it was 28.3 cm. (42,1 percentile). At 40 weeks and at 2 years, the average measures were similar. The CAH chorioamnionitis subtype was found to be associated with PC growth retardation (p<0,05). A lesser gestational age (p=0.005) was related with greater cranial growth speed. Conclusions : Newborns younger than 34 weeks exposed to CAH had lower HC percentile at birth. We observed a recovery of HC at 40 weeks. The chorioamnionitis subtype was related to lower HC at 2 years of corrected age. Intrauterine growth restriction (IUGR) enhanced this association at these three points, while sepsis did so only at 40 weeks. Further research is required to confirm these findings.

Subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis in women with spontaneous preterm delivery

OBJECTIVE: To compare subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis (HCA) in women with spontaneous preterm delivery (SPTD).METHODS: Among 1,706 women who gave birth twice or more at our institution, 138 women delivered spontaneously at preterm (<37.0 weeks). Subsequent deliveries occurred at our institution and placental biopsy results were available. The study population was categorized into 2 groups based on the presence of acute HCA at the time of SPTD: HCA group (n=52) and non-HCA group (n=86). The primary outcome measures were gestational age at delivery, birthweight, and frequency of preterm delivery in subsequent pregnancies.RESULTS: The median gestational age at the time of SPTD was 34.0 weeks (interquartile range [IQR], 28.9–35.3 weeks), and the frequency of acute HCA was 52/138 (38%). There were no differences in gestational age at delivery, birthweight, and frequency of preterm delivery between the HCA group and non-HCA group (median gestational age at delivery, 38.0 weeks (IQR, 36.7–38.8 weeks) in the HCA group vs. 37.9 weeks (IQR, 35.7–39.0 weeks) in the non-HCA group; frequency of preterm delivery, 14/52 (27%) in the HCA group vs. 33/86 (38%) in the non-HCA group; and median birthweight, 3.14 kg (IQR, 2.64–3.45 kg) in the HCA group vs. 2.95 kg (IQR, 2.44–3.36 kg) in the non-HCA group; P>0.1 for all.CONCLUSION: The presence of acute HCA in women at prior SPTD did not significantly affect their subsequent pregnancy outcomes.

Duration of Preterm Premature Rupture of Membranes as Predictor of Histologic Chorioamnionitis and Early Onset Neonatal Sepsis: A cohort study

Background@#Preterm premature rupture of membranes (PPROM) has been associated with chorioamnionitis but studies are inconsistent on the relationship between PPROM latency and the risk of chorioamnionitis and early onset sepsis.@*Objective@#To define the association of PPROM latency and the risk of histologic chorioamnionitis (HCA) and early onset neonatal sepsis (EONS). @*Methodology@#A prospective cohort study was done at a public tertiary hospital on 569 mothers with spontaneous rupture of membranes and with fetuses EONS was defined using test of association and Receiver Operating Characteristics (ROC) curve analysis. The association of HCA with maternal and neonatal characteristics as well as adverse neonatal outcomes were also determined. @*Results@#A total of 569 mothers with PPROM were included. Incidence of HCA and EONS were 13% and 24% respectively. PPROM latency was significantly associated with HCA and is a fair predictor of HCA (AUC = 0.7013; 76% accuracy at 31.5-hour cut-off) but failed as a predictor of EONS (AUC = 0.4799). PPROM, platelet count, CRP, and neutrophil count were ndependent predictors of HCA. HCA was associated with EONS and mortality. Mortality was higher in the presence of both HCA and EONS. @*Conclusion@#Longer PPROM is associated with HCA and is a fair predictor of HCA at a cut-off of 31.5 hours. PPROM fails as a predictor of EONS.

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.

Cerclaje profiláctico en mujeres con nacimientos prematuros espontáneos previos, asociados con infección bacteriana ascendente / Prophylactic cerclage in women with spontaneous premature deliveries associated to ascending bacterial infection

Objetivo: Determinar la eficacia del cerclaje cervical profiláctico en pacientes con embarazos únicos, cérvix >25 mm e historia de nacimientos prematuros espontáneos, asociados con infección bacteriana ascendente (IBA). Métodos: Estudio clínico en pacientes con embarazos únicos y partos prematuros y/o abortos de 2° trimestre espontáneos previos, sin partos de término, asociados con IBA. Se incluyeron los casos con longitud cervical de >25 mm al ingreso. Se comparó el cerclaje cervical hecho en pacientes derivadas antes de las 20 semanas, con el manejo expectante en mujeres enviadas después de esta edad gestacional y que mantuvieron longitud cervical >25 mm durante los controles. Se excluyeron embarazadas con cérvix <25 mm al ingreso del estudio, con acortamiento cervical <25 mm durante el manejo con conducta expectante y mujeres con nacimientos prematuros previos sin histología placentaria. Resultados: Se incluyeron 51 pacientes, 23 con cerclaje y 28 sin cerclaje. El cerclaje cervical profiláctico, redujo significativamente la frecuencia del nacimiento prematuro <37semanas (4,3 por ciento vs 35,7 por ciento), <34 semanas (4,3 por ciento vs 28,6 por ciento) y la corioamnionitis histológica (4,3 por ciento vs 32,1 por ciento), OR (IC95 por ciento) 0,08 (0,09-0,70), 0,11(0,01-0,99) y 0,01 (0,010,83), respectivamente. Conclusiones: En pacientes con nacimientos prematuros previos asociados con IBA, embarazo único y longitud cervical >25 mm, el cerclaje profiláctico, reduce la frecuencia del nacimiento prematuro <37 y <34 semanas y de la corioamnionitis histológica.

Aims: Determine the effectiveness of prophylactic cerclage in women with singleton pregnancies, cervix >25 mm and a history of spontaneous premature deliveries associated to ascending bacterial infection (ABI). Methods: Women with singleton pregnancies and history of preterm births, with no full term deliveries, associated to ABI. Cases with >25 mm cervical length at admission were included. Cervical cerclage performed on patients derived before 20 weeks of pregnancy was compared to the expectant management of women submitted at a later gestational stage with sustained cervical length of >25 mm. Pregnant women with <25 mm cervix at referral, with cervical shortening <25 mm at expectant management, and women with previous preterm birth without placental histology were excluded. Results: 51 patients were included, 23 with cerclage and 28 without cerclage. Prophylactic cerclage significantly reduced the frequency of premature birth <37 weeks, 4.3 percent vs 35.7 percent and <34 weeks, 4.3 percent vs 28.6 percent and histologic chorioamnionitis 4.3 percent vs 32.1percent (9/28), OR (95 percent CI) 0.08 (0.09-0.70), 0.11(0.01-0.99) and 0.01 (0.01-0.83), respectively. Conclusions: In patients with preterm births associated to ABI, singleton pregnancy and cervical length >25 mm, prophylactic cerclage reduces the frequency of premature delivery <37 and <34 weeks as well as histologic chorioamnionitis.

The Effects of Histologic Chorioamnionitis and Funisitis on Outcome of Very Low Birth Weight Infants / 대한주산의학회잡지

PURPOSE: The association of chorioamnionitis and preterm birth, chronic lung disease (CLD) and periventricular leukomalacia (PVL) has been reported, however, controversy is still present. The aim of this study was to investigate how the histologic chorioamnionitis (HC) and/or funisitis (F) affected the clinical outcomes of very low birth weight infants (VLBWI, <1,500 g). METHODS: The medical records of VLBWI who were admitted at NICU, Chonnam University Hospital from 2004 to 2008 with placental biopsy results were reviewed retrospectively. Maternal (n=324) and neonatal (n=363) characteristics and their clinical outcomes were investigated according to placental pathology. RESULTS: HC (+) mothers (n=88) had higher premature rupture of membranes and preterm labor, and lower rates of preeclampsia/eclampsia (p<0.05 at each) than HC (-) mothers (n=236). HC (+) infants (n=103) had lower birth weight and Apgar score, higher rate of Cesarean section and lower intrauterine growth restriction (p<0.05 at each) rates than HC (-) infants (n=260). HC (+) infants had higher rates of respiratory distress syndrome and mortality, and lower rate of necrotizing enterocolitis (p<0.05 at each), however, when adjusted for verified multivariables in the multiple regression analysis, HC didn't affect the clinical outcomes. CONCLUSION: It was known that intrauterine infection or fetal inflammatory response syndrome (FIRS) was associated with neonatal outcomes. However, our results suggest that HC with or without funisitis is not an isolated risk factor to affect the clinical outcomes in VLBWI.

The Effect of Histologic Chorioamnionitis on the Development of Respiratory Distress Syndrome and Chronic Lung Disease in Preterm Infants / 소아과

PURPOSE: Histologic chorioamnionitis may play a role in the development of respiratory distress syndrome(RDS) and chronic lung disease(CLD) independently or through its association with preterm birth. We investigated the relationship between histologic chorioamnionitis and clinical complications including, RDS and CLD, of preterm infants. METHODS: Clinical data were collected retrospectively from 478 preterm infants(gestational period< or =34 weeks) who were admitted to the neonatal intensive care unit(NICU) in Seoul National University Children's Hospital from January 1993 to December 2000. RESULTS: Histologic chorioamnionitis(CA) was observed in 210 of 478 infants(44%). Lower gestational period was detected in CA(+) group(31+1 +/- 2+2 weeks vs. 30+1+/-2+3 weeks). CA(+) group had decreased incidence of RDS(38.4% vs. 28.1%)[odds ratio, OR 0.35(P=0.0004, 95% confidence intervals, CI 0.19-0.63)], and increased incidence of CLD(7.5% vs. 13.3%)[OR 1.95(P=0.047, 95% CI 1.01-3.79)] combined much more "atypical CLD"(10.5% vs. 55.6%). CA(+) group had decreased incidence of patent ductus arteriosus(33.3% vs. 25.4%)[OR 0.37(P=0.003, 95% CI 0.19-0.71)]. There was no difference between the two groups in birth weight. CONCLUSION: It is suggested that intrauterine infections and fetal inflammatory responses might play a role in the outcome of preterm infants, and histologic chorioamnionitis is an isolated risk factor in the development of RDS and CLD of the preterm infants.

The diagnostic and prognostic value of amniotic fluid white blood cell count in patients with preterm premature rupture of the membranes / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was 1) to determine the diagnostic performance of amniotic fluid white blood cell (WBC) count for the antenatal detection of intrauterine infection and 2) to identify the value in prediction of preterm birth and significant neonatal morbidity in patients with preterm premature rupture of membranes. METHODS: Transabdominal amniocentesis was done in 255 singleton pregnancies with preterm premature rupture of membranes before 36 weeks of gestational age. Amniotic fluid was cultured for aerobic and anaerobic bacteria and mycoplasmas. Receiver-operator characteristic curve, survival analysis and logistic regression were used for statistical analysis. RESULTS: 1) Prevalence of positive amniotic fluid culture was 19.6% (50/255). Amniotic fluid WBC count was higher in the patients with positive amniotic fluid culture than those with negative amniotic fluid culture (median 269 [0-19764] cells/mm3 vs median 2 [0-7956] cells/mm3, p or = 20 cells/mm3) had sensitivity of 74%, specificity of 74%, positive predictive value of 41% and negative predictive value of 92% for the positive result of amniotic fluid culture. 3) An increased amiotic fluid WBC was strongly associated with shorter amniocentesis-to-delivery interval even after adjustment of gestational age at amniocentesis(hazard ratio 3.2736, p<0.0001). 4) Amniotic fluid WBC count was higher in patients with significant neonatal morbidity or congenital neonatal infectious morbidity than those without these (p<0.001 and p<0.005 respectively). 5) Patients with increased amniotic fluid WBC count had higher incidence of significant neonatal morbidity and congenital neonatal infectious morbidity than those with low amniotic fluid WBC count and the association between amniotic fluid WBC and significant neonatal morbidity was statistically significant after adjustment of gestational age at amniocentesis (OR 3.3649, p<0.0001). CONCLUSION: Amniotic fluid WBC count is of value in antenatal diagnosis of intrauterine infection and prediction of maternal and neonatal outcomes in patients with preterm premature rupture of membranes.

The Association of Histologic Chorioamnionitis and Bronchopulmonary Dysplasia in Prematurity / 대한산부인과학회잡지

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is one of the most frequent and clinically significant complications of prematurity and it has been widely accepted that immaturity, barotrauma, and oxygen toxicity are major factors in the etiology of BPD. However, recent studies showed that infection may also play a role in the pathogenesis of BPD and exposure to a prenatal inflammatory process may lead to lung injury and predispose to the subsequent development of BPD. The purpose of this study was to test the hypothesis that neonates with BPD had higher incidence of histologic chorioamnionitis than those in whom BPD does not develop. METHODS: A retrospective study was conducted to examine the relationship between histologic chorioamnionitis and the occurrence of BPD in neonate. We reviewed the hospital charts of 363 women and their neonates whose gestational age at birth were between 24 weeks and 35 weeks and recorded their pregnancy outcomes, the results of placental Biopsy, perinatal outcomes including the occurrence of BPD. RESULTS: 1. Neonates who developed BPD showed higher incidence of acute histologic chorioamnionitis. The relationship remained significant even after the adjustment for gestational age (odds ratio, 3.2: 95% confidence interval, 1.6-11.3: P<0.05). 2. Higher maternal serum CRP was also associated with increased incidence of histologic chorioamnionitis and BPD (P<0.05). 3. Neonates who developed BPD also had higher incidence of infectious morbidity such as early neonatal pneumonia and sepsis (P<0.05). CONCLUSION: These results suggest that histologic chorioamnionitis is closely related to the occurrence of BPD. This support the hypothesis that intrauterine infection may cause fetal lung injury and subsequent development of BPD.

The relationship between amniotic fluid tumor necrosis factor- , histologic chorioamnionitis, and congenital sepsis in preterm labor / 대한산부인과학회잡지

OBJECTIVE: Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor- are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor- for this outcome variable. METHODS: The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor- concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor- was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis. RESULTS: 1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor- concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p or =4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor- were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p or =41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor- (> or =41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p<0.05) after correction for known confounding variables [i.e., low gestational age at birth (< or =32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)]. CONCLUSION: Test of amniotic fluid tumor necrosis factor- is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor- is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.

A comparative study of the diagnostic value of amniotic fluid interleukin-6 and culture for the antenatal diagnosis of intrauterine infection and prediction of perinatal morbidity in patients with preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVES: Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables. METHOD: The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. RESULTS: 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; P < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively). CONCLUSIONS: Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.

The relationship between amniotic fluid white blood cell count and the presence and severity of acute placental inflammation in preterm premature rupture of membrane / 대한산부인과학회잡지

OBJECTIVE: Acute inflammatory lesions in the placenta is one of the most common histopathologic lesions of women with preterm premature rupture of membrane. But there is a few scientific evidence to support the association between amniotic fluid white blood cell count and the presence and severity of acute placental inflammation in preterm premature rupture of membrane. To evaluate the relationship between amniotic fluid white blood cell count and the presence and severity of acute placental inflammatory lesions in preterm premature rupture of membrane. METHODS: The relationship between amniotic fluid white blood cell count and placental histologic finding was examined in 89 consecutive patients who were admitted with the diagnosis of preterm premature rupture of membrane and who delivered singleton gestation within 3 days. RESULTS: The prevalence of acute histologic chorioamnionitis was 68.5%(61/89) and that of positive amniotic fluid culture was 32.6%(29/89). The prevalence of positive amniotic fluid culture increased according to the higher severity of inflammation in each type of placental section(p<0.05 for each). The median amniotic fluid white blood cell count increased significantly according to the presence and higher severity of inflammation in each type of placental section(p<0.01 for each). The median amniotic fluid white blood cell count increased significantly according to the higher total grade of inflammation in placental histologic examination(p<0.01). CONCLUSION: Both the presence and higher severity of acute histologic chorioamnionitis are associated with an elevated amniotic fluid white blood cell count. The total grade of acute histologic chorioamnionitis is associated with an elevated amniotic fluid white blood cell count. Amniotic fluid white blood cell count is a reliable prenatal marker of histologic chorioamnionitis."

The relationship between the presence, severity and pattern of acute placental inflammation and amniotic fluid interleukin-8 in preterm labor / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between amniotic fluid interleukin-8 and the presence, severity and pattern of acute inflammatory lesions in the placenta delivered after preterm labor with intact membranes. METHODS: The relationship between placental histologic finding and amniotic fluid interleukin-8 was examined in 46 consecutive patients who were admitted with the diagnosis of preterm labor with intact membranes and who delivered singleton gestations within 5 days. RESULTS: The prevalence of acute histologic chorioamnionitis was 63.0%(29/46) and that of positive amniotic fluid culture was 17.4%(8/46). The most frequent site of histologic inflammation was chorion-decidua(56.5%, 26/46). The median amniotic fluid interleukin-8 increased significantly according to the presence and higher severity of inflammation in each type of placental section (p or = 4) increased significantly in the order of non-marginating, marginating, and mixed (p<0.05 for each). CONCLUSION: Both the presence and greater severity of acute histologic chorioamnionitis are associated with an elevated amniotic fluid interleukin-8. A marginating and mixed pattern of inflammation are associated with a higher amniotic fluid interleukin-8. Amniotic fluid interleukin-8 is a reliable prenatal marker of histologic chorioamnionitis.

A comparative study of amniotic fluid white blood cell count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of perinatal outcomes in women with preterm labor and intact membranes / 대한산부인과학회잡지

OBJECTIVES: To compare the diagnostic and prognostic performance of amniotic fluid white blood cell(AF WBC) count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of neonatal outcomes in patients with preterm labor and intact membranes. Methods: Amniocentesis was performed in 75 patients with preterm labor and intact membranes, who delivered preterm neonates within 72 hours after amniocentesis. AF WBC was determined and amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasma. The relations among placental histologic findings, perinatal outcome, AF WBC count, and AF culture were examined. Student t test, Mann Whitney U test, lamda2 test, Fisher's exact test, modified t test, and logistic regression analysis were used for statistical analysis. RESULTS: Microbial invasion of the amniotic fluid was more frequent in the patients with histologic chorioamnionitis than patients without histologic chorioamnionitis (28.9% vs 5.4%, p or = 50cell/mm3) had a sensitivity of 55.3%(21/38) and a specificity of 94.6%(35/37) for the diagnosis of histologic chorioamnionitis and a sensitivity of 47.5%(19/40) and specificity of 90.9%(30/33) for the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis). These sensitivities were significantly higher than those of amniotic fluid culture (for histologic chorioamnionitis, 55.3% vs 28.9% ; for significant neonatal morbidity, 47.5% vs 25.0%, p<0.01 for each). CONCLUSION: Amniotic fluid WBC count is a more sensitive test for the prenatal diagnosis of intrauterine infection and for the prediction of significant neonatal morbidity than amniotic fluid culture in the patients with preterm labor and intact membranes.

The Association with Amniotic Fluid Interleukin-6 and Histologic Chorioamnionitis in Patients with Preterm Labor and Intact Membranes / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine whether amniotic amniotic fluid concentrations of interleukin-6 are valuable in the prediction of histologic chorioamnionitis and in the prediction of perinatal morbidity. STUDY DESIGN: The relation among amniotic fluid imterleukin-6, histologic chorioamnionitis, and perinatal outcome was examined in patients with preterm labor and intact membranes. Interleukin-6 was determined by ELISA method. RESULTS: Patients with histologic chorioamnionitis had significantly higher amniotic fluld interleukin-6 concentrations than patient without histologic chrioamnionitis. Also, patient with histologic chorioamnioitis had significantly higher perinatal morbidity rate than patient without histologic chorioamnionitis. An ammiotic fluld interlerkin-6 concentration had a sensitivity of 75% and a specificity of 62.5% in the diagnosis of preterm delivery. CONCLUSION: Amniotic fluld interleukin-6 is a sensitive test for the prediction of histologic chorioamnionitis and of perinatal morbidity.

The Diagnostic and Prognostic Value of Maternal Blood C-reactive Protein in Patients with Preterm Labor and Intact Membranes / 대한산부인과학회잡지

BACKGROUND: Intrauterine infection has been recognized as a major etiologic factor for preterm labor and delivery. Moreover, an accumulating body of evidence suggests that intrauterine infection is associated with poor perinatal outcome. Several antenatal tests, including amniotic fluid tests, have been proposed to be useful in the identification of intrauterine infection and prediction of adverse perinatal outcome in patients with preterm labor and intact membranes. However, those tests require the performance of an invasive procedure, amniocentesis. Maternal blood C-reactive protein(CRP) has been studied extensively as a noninvasive test in the diagnosis of intrauterine infection. OBJECTIVE: 1) to determine the diagnostic performance of maternal bood CRP in identification of intrauterine infection and 2) to establish the prognostic value of maternal blood CRP as an antepartum test for neonatal morbidity, especially sepsis, in neonates born to mothers with preterm labor and intact membrances. STUDY DESIGN: Maternal blood samples for CRP tests were obtained at the time of admission in 91 patients with preterm labor and intact membranes. Serum CRP concentrations were measured by antibody adsorption-particle agglutination assay technique. Histologic examination of delivered placenta and follow-up for maternal and neonatal outcome were performed. Receiver-operator characteristic(ROC) curve, logistic regression, and survival analysis techniques were used for statistical analysis. RESULTS: Patients with acute histologic chorioamnionitis had significantly higher median maternal blood CRP concentration than did patients without this lesion. ROC curve and survival analysis demonstrated that an elevated CRP concentration was strongly associated with the likelihood of acute histologic chorioamnionitis, shorter admission-to-delivery interval, significant neonatal morbidity, and neonatal sepsis. Multiple logistic regression analysis indicated that maternal blood CRP was a significant independent predictor for the occurrence of neonatal morbidity and neonatal sepsis even after adjustment of other independent variables. CONCLUSION: The results of this study suggest that maternal blood CRP has a diagnostic and prognostic value in patients with preterm labor and intact membranes.