ABSTRACT
OBJECTIVE: To compare the cervicovaginal cytokines IL-1beta, IL-6 and IL-8 with fetal fibronectin (fFN) and cervical dilatation in the prediction of preterm delivery. STUDY DESIGN: Cervicovaginal cytokine concentration and fFN status were measured in 104 women with symptoms of preterm labour and intact membranes between 24(0) and 33(6) weeks and related to delivery within 2 and 7 days. RESULTS: A group of 18% had cervical dilatation > or = 1cm and 18% were positive for fFN. Preterm delivery within 2 and 7 days occurred in 5 and 12%, respectively. Only IL-6 demonstrated any ability to predict delivery within 2 and 7 days (area under the ROC curve = 0.63 and 0.75, respectively). Using 35pg/ml (75th centile) as a cut-off, IL-6 had a sensitivity and specificity of 60 and 77% for predicting delivery within 2 days, and 62 and 80% for predicting delivery within 7 days. This is similar to the performance of cervical dilatation or fFN status. CONCLUSIONS: Measurement of cervicovaginal cytokines has limited ability to predict imminent delivery apart from cervicovaginal IL-6 concentrations, which, in this population, is equivalent to that of fFN status and cervical dilatation > or = 1cm.
Subject(s)
Cervix Uteri/metabolism , Cervix Uteri/physiopathology , Fibronectins , Glycoproteins/analysis , Interleukins/analysis , Obstetric Labor, Premature/diagnosis , Vagina/metabolism , Adult , Female , Gestational Age , Humans , Interleukin-1/analysis , Interleukin-6/analysis , Interleukin-8/analysis , Logistic Models , Pregnancy , Prospective Studies , ROC CurveABSTRACT
The aim of this retrospective study was to identify risk factors for meconium-aspiration syndrome, and to identify antenatal and intrapartum risk factors which might be preventable. We analyzed maternal and neonatal records of the 210 infants who had meconium-stained liquor and who also developed respiratory distress necessitating admission to the Special Care of Intensive Care Baby Units at National Women's Hospital, Auckland in 1992. Meconium-aspiration syndrome occurred in 6.6% of meconium exposed babies and in 1.3% of total births. Severe meconium-aspiration syndrome developed in 18 infants, moderate in 48, mild in 60 respiratory distress in 84. An association was found between meconium aspiration syndrome and primiparity (p = 0.001) and Pacific Island ethnicity (p = 0.0002). An association was also found between the severity of meconium and low umbilical artery pH (p = 0.0002). Thick meconium and an abnormal cardiotocograph were more common in severe meconium-aspiration syndrome. All deaths and long-term morbidity occurred in babies with abnormal cardiotocographs or in unmonitored infants. Preventable antenatal and intrapartum factors were not identified in this study.
