Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage

ABSTRACT Purpose: To determine the predictive value of maternal White Blood Cells (WBC), neutrophils, and C-Reactive Protein (CRP) for diagnosing Histological Chorioamnionitis (HCA) among women with Preterm Premature Rupture of Membranes (PPROM) who underwent cervical cerclage. Methods: A retrospective cross-sectional study was conducted among women with singleton pregnancy and PPROM, who underwent cervical cerclage during 2018-2020. Results: A total of 55 eligible women were included in the final analysis, including 36 (61.02%) cases with HCA and 19 (38.98%) without HCA. Women with HCA had higher WBC count (12.31 ± 2.80) × 109/L and neutrophil count (9.67 ± 2.90)×109/L than those without HCA (10.35 ± 2.53) × 109/L and 7.82 ± 2.82 × 109/L, respectively) (both p < 0.05). The cut-off value of WBC count at 10.15×109/L was found to be the most effective in identifying HCA, with an Area Under Curve (AUC) of 0.707 (95% CI: 0.56-0.86; p = 0.012), sensitivity of 86.11%, specificity of 57.90%, Positive Predictive Value (PPV) of 79.49%, Negative Predictive Value (NPV) of 68.75%, and Youden index of 0.44. The combination of WBC + neutrophil had a slightly higher (AUC = 0.711, 95% CI: 0.57-0.86; p = 0.011), specificity (68.42%), and PPV (81.25%), but lower sensitivity (72.22%), than the WBC count alone. A cut-off value of neutrophil at 7.46 × 109/L was effective in identifying HCA, with an AUC of 0.689 (95% CI: 0.53-0.84; p = 0.022). Discussion: Combination use of WBC+neutrophil was found to be the most accurate predictor of HCA among women with PPROM after surgery of cervical cerclage.

Riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica, Lima, Perú / Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis Lima, Peru

RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.

ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.

Prevalence of histologic chorioamnionitis in patients with spontaneous pre-term labour in Popayán, Colombia, 2014-2016 / Prevalencia de corioamnionitis histológica en pacientes con trabajo de parto espontáneo. Popayán, Colombia, 2014-2016

ABSTRACT Objective: To determine the presence of histologic chorioamnionitis in pregnant women in spontaneous pre-term labour, and to evaluate potential risk factors and association with clinical and paraclinical signs and symptoms. Materials and methods: Descriptive prevalence study with secondary exploratory analysis in pregnant women under 37 weeks of gestation with spontaneous delivery in whom the placenta was used for histopathology testing, conducted over a 2-year period in a high complexity hospital in Popayán, Colombia. Secondary pre-term deliveries were excluded. Consecutive sampling, with a sample size of 166 pregnant women. Social, demographic, clinical, laboratory and imaging variables were measured, as well as the placental histopathology test result. The analysis estimated the prevalence of histological chorioamnionitis period. The prevalence ratio as a measure of association and the diagnostic OR (DOR) with its respective 95% confidence interval were obtained. Results: Overall, 160 pregnant women and their placentas were analyzed over a 2-year period. There were positive reports for 110 placentas with histological chorioamnionitis, for a prevalence of 68.75 % (95 % CI: 61.49-76.00), the prevalence being higher in gestations under 34 weeks (PR= 1.48; 95 % CI: 1.20-1.83). Regarding association of signs and symptoms, a significant association was found with fever (DOR= 4.7; 95% CI: 1.05-21.09), maternal tachycardia (DOR = 4.22; 95% CI: 1.81-9.81), foetal tachycardia (DOR = 3.74; 95% CI: 1.23-11.35), absent breathing movements (DOR = 5.16; 95 % CI: 1.43-18.60), amniotic fluid lower than 2 (DOR= 5.67; 95 % CI: 1.24-25.98), and presence of neutrophilia (DOR = 2.97; 95 % CI: 1.44-6.12). Conclusions: The prevalence of histological chorioamnionitis was 67 % in pre-term deliveries and varied in accordance with gestational age.

RESUMEN Objetivo: Determinar la prevalencia de la corioamnionitis histológica en gestantes con trabajo de parto pretérmino espontáneo, evaluar posibles factores de riesgo y la asociación con signos clínicos y paraclínicos. Materiales y métodos: Estudio descriptivo de prevalencia, con análisis secundario exploratorio en gestantes con embarazo menor a 37 semanas de gestación, con parto espontáneo, en quienes se dispuso de sus placentas para estudio histopatológico, durante un periodo de 2 años, en un hospital de alta complejidad en Popayán, Colombia. Se excluyeron partos pretérmino secundarios. Muestreo consecutivo, con tamaño muestral de 166 gestantes; se midieron variables sociodemográficas, clínicas, de laboratorio e imágenes diagnósticas, y resultado histopatológico de la placenta. En el análisis se estimó la prevalencia de periodo de corioamnionitis histológica. Se obtuvo la razón de prevalencias como medida de asociación y el OR diagnóstico (ORD) con su respectivo intervalo de confianza al 95 %. Resultados: En un periodo de 2 años se analizaron 160 gestantes y sus placentas, 110 placentas fueron reportadas como positivas para corioamnionitis histológica con una prevalencia de 68,75 % (IC 95 %: 61,49-76,00), esta fue más prevalente en gestaciones menores de 34 semanas (RP= 1,48; IC 95 %: 1,20-1,83). En cuanto a la asociación de los síntomas y signos se encontró asociación significativa con la fiebre (ORD = 4,7; IC 95 %: 1,05-21,09), la taquicardia materna (ORD = 4,22; IC 95 %: 1,81-9,81), la taquicardia fetal (ORD = 3,74; IC 95 %: 1,23-11,35), movimientos respiratorios ausentes (ORD = 5,16; IC 95 %: 1,43-18,60), lago de líquido amniótico menor a 2 cm (ORD = 5,67; IC 95 %: 1,24-25,98), y presencia de neutrofilia (ORD = 2,97; IC 95 %: 1,44-6,12). Conclusiones: La prevalencia de corioamnionitis histológica es del 67 % en los partos pretérmino y varió en función de la edad gestacional.

TLR4/NF-κB signal pathway mediate HBD-2 in patients with preterm premature rupture of membrane associated with histologic chorioamnionitis / 中国综合临床

Objective To observe the effect of human β-defensins-2(HBD-2) for chorioamnionitis(HCA) pregnant women before term premature rupture of fetal membrane(PROM) process,and explore toll-like receptor 4 / nuclear factor-κ B (TLR4 / NF-κB) predominate role in the process of signal transduction pathway in the mechanism.Methods Fifty five women with PROM were enrolled in the study.According to the Results of pathological diagnosis of membranes,pregnant women with PROM divided into histological chorioamnionitis,HCA and non-HCA.The same sample without PROM pregnancies matching the same gestational ages were recruited as control group.We examined the messenger RNA(mRNA) of TLR4,NF-κB p65 and HBD-2 in placenta and fetal membrane real-time reverse transcription polymerase chain reactions by dsDNA-binding dyes of SYBR Green.Results (1)In the placenta,the level of TLR-4(17.15±4.52),NF-κB p65(47.11±14.23),HBD-2mRNA(27.35±2.67) in PROM group were significantly higher than the level of TLR-4(7.21±3.25),NF-κB p65(30.51±13.05),HBD-2mRNA(13.55±0.8) in control group(t=-1.966,-1.474,-1.754,P0.05).Conclusion Linear positive correlation of TLR4,NF-κB and HBD2 indicated that TLR4/NF-κB/HBD2 signal transduction pathway may be involved in the development of preterm premature rupture of membrane associated with histologic chorioamnionitis.

The relationship between histological chorioamnionitis,fetal vasculitis and the morbidity of neonatal respira-tory distress syndrome / 中国小儿急救医学

Objective To explore the relationship between histological chorioamnionitis(HC),fetal vasculitis(FV)and the morbidity of neonatal respiratory distress syndrome(RDS).Methods Three hundred and forty-seven cases of infants at the gestational ages of 28 +0 to 31 +6 weeks who were admitted to the Neo-natology Department of our hospital from October 2009 to June 2013 were analyzed retrospectively.They were divided into four groups according to the occurrence of HC and FV,namely,HC positive group and HC negative group,FV positive group and FV negative group.The patients in the HC positive group were further divided into FV positive group and FV negative group according to the occurrence of FV.The morbidity of RDS among above-mentioned groups was compared.Results The clinical characteristics including propor-tion of male,gestational age,birth weight,cesarean delivery,antenatal corticosteroid use,gestational hyperten-sion,gestational diabetes and cholestasis of pregnancy showed no statistically significant difference among all the groups(P 〉0.05).The incidence of RDS in the HC positive group(145 cases)was 49.6%(72 cases), which was significantly lower than that in the HC negative group(67.3%,126 /202,P 〈0.05).The incidence of RDS in FV positive group(64 cases)was 42.2%(27 cases),which was significantly lower than that in FV negative group(63.3%,179 /283,P 〈0.05)In the HC positive group(145 cases),the incidence of RDS in FV positive group (64 cases)was 42.2% (27 cases),and 55.6% (45 cases)in FV negative group (81 cases),which showed no significant difference(P ﹦0.01 ).Conclusion (1 )HC or FV can reduce the incidence rate of RDS in premature infants.(2)HC combined FV cannot furtherly reduce the incidence of RDS.

A correlational analysis of histological chorioamnionitis and brain injury in preterm infants / 临床儿科杂志

Objective To explore the correlation between histological chorioamnionitis (HC) and brain injury in preterm infants. Methods Three hundred and forty-seven cases of infants at the gestational age of 28-31 weeks who were admitted to the neonatology department of our hospital were analyzed retrospectively. They were divided into the HC group and the control group according to the pathological examination. Moreover, HC group was divided into FV group and non-FV group according to the pathological findings of fetal vasculitis (FV). Based on the findings of periodical ultrasonography, the incidences of periventricular leukomalacia (PVL), periventricular-intraventricular hemorrhage (PVH-IVH), and the PVL+PVH-IVH were compared among groups. Results The incidences of PVL in the HC group and the control group were 17.9% and 10.3%respectively. The incidences of PVL+PVH-IVH in the two groups were 5.5%and 1.48%respectively, and the difference between two groups was signiifcant (P0.05). In the HC group, the incidences of PVL in FV group and non-FV group were 28.1%and 9.87%respectively, and the difference between two groups was signiifcant (P0.05). The incidences of PVL+PVH-IVH in FV group and non-FV group were 7.81%and 3.70%respectively, and the difference between the two groups was not have signiifcant (P>0.05). Conclusions HC may increase the ncidences of PVL and PVL+PVH-IVH in the preterm infants, while its effect is minimal on PVH-IVH. FV could increase the incidence of brain injury in preterm infants.

Proteína C reactiva y marcadores de estrés oxidativo como predictores de la corioamnionitis histológica y el parto pretérmino / CRP and oxidative stress markers as predictors of histological chorioamnionitis and preterm birth

Introducción: la determinación de biomarcadores que permitan el diagnóstico precoz de la corioamnionitis histológica y el parto pretérmino constituye un tema de interés debido a las complicaciones para la salud del recién nacido y la repercusión social que acarrean estas dos entidades. A pesar de los múltiples estudios llevados a cabo aún no se cuentan con biomarcadores que permitan la predicción de forma efectiva de ambas entidades. Objetivo: en la actual revisión bibliográfica se pretendió abordar la posible relación y uso en el diagnóstico de dos biomarcadores del suero materno: la proteína C reactiva y los marcadores de estrés oxidativo, con respecto a la corioamnionitis histológica y el parto pretérmino. Métodos: se realizó una búsqueda en las bases de datos Pubmed, SciELO, Hinari y Lilacs en relación con el tema. Resultados: a pesar que la proteína C reactiva en suero materno es empleada de forma rutinaria como un marcador en el seguimiento de la corioamnionitis clínica, en la literatura consultada existen estudios a favor y en contra con respecto al diagnóstico de la corioamnionitis histológica y al parto pretérmino y aunque son escasos los estudios en suero materno, se ha establecido una relación estrecha entre los marcadores de estrés oxidativo y la inflamación, siendo ambos causantes de ambas entidades. Conclusiones: se recomiendan las determinaciones cuantitativas seriadas y el uso de la proteína C reactiva de alta sensibilidad en el seguimiento de estas patologías. Son pocos los estudios acerca del valor predictivo de los marcadores de estrés oxidativo para ellas.

Introduction: biomarkers determination allowing the early diagnose of histological chorioamnionitis and preterm birth is a scientific interest due to the complications for the newborn health and social repercussion that this two entities brings along. Despite the multiples studies carried out about this issue, there are not biomarker which can efficiently predict both pathologies yet. Objectives: the current literature review was intended to address the possible relationship and use in diagnosing of two maternal serum biomarkers: C-reactive protein and oxidative stress markers, with regard to histological chorioamnionitis and preterm delivery. Methods: a search was made in Pubmed, Hinari, Scielo and Lilac's data bases. Results: although C-reactive protein in maternal serum is routinely used as a marker in monitoring clinical chorioamnionitis in the literature, there are studies favoring and against the diagnosis of histological chorioamnionitis and childbirth preterm and although there are few studies on maternal serum, a close relationship has established between inflammation and oxidative stress markers, both are cause these entities. Conclusions: the serial quantitative determinations and the use of high sensitivity CRP are recommended in monitoring these pathologies. There are few studies on the predictive value of oxidative stress markers for them.