Role of maternal plasma procalcitonin levels in the prediction of subclinical infection in patients with preterm premature rupture of membranes

ABSTRACT

To compare maternal plasma procalcitonin [PCT] concentrations in cases of preterm premature rupture of membranes [pPROM] and premature rupture of membranes [PROM] at term, and to determine whether these concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval. A total of 90 women with singleton pregnancies were enrolled in this study, 25 patients with pPROM, 25 with PROM at term, 20 healthy women at preterm gestation, and 20 healthy women at term were included. In pPROM group, analysis of PCT concentrations with reference to serum leucocytosis, serum C-reactive protein levels, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis was carried out. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval. PCT concentrations in pPROM and PROM at term cases were significantly higher than in healthy controls in approximate gestational age [40.84 +/- 11.64, 9.19 +/- 4.81 [pPROM, PROM at term cases], 3.33 +/- 1.40, 2.41 +/- 0.91 [preterm and term healthy controls], respectively, p<0.001]. In pPROM group, no significant correlation was observed between PCT and leucocytosis [p=0.458] or C-reactive protein [p=0.188]. Also no statistically significant difference was found between PCT concentrations in patients who gave birth to newborns with and without congenital infection, and in patients with and without histological chorioamnionitis [p=0.591, 0.091 respectively]. The accuracy of procalcitonin determinations were poor. The value of maternal plasma PCT determinations in the diagnosis of pPROM cases suspected of intra-amniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, PCT concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnant mothers, and therefore further evaluations are necessary to establish the role and relative contribution of PCT levels in the prediction of subclinical intrauterine infection in pPROM cases