Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes.

Abstract

OBJECTIVE:

This study was conducted to determine the frequency and clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of the membranes.

STUDY DESIGN:

Amniotic fluid was retrieved from 219 patients with preterm premature rupture of the membranes; the fluid was cultured for aerobic and anaerobic bacteria and mycoplasmas and assayed for neutrophil collagenase, which is also known as matrix metalloproteinase-8. Matrix metalloproteinase-8 was used because previous studies indicated that this was a sensitive and specific index of inflammation and that is correlated with the amniotic fluid white blood cell count. Intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration (>23 ng/mL). Nonparametric and survival techniques were used for statistical analysis.

RESULTS:

The overall rate of intra-amniotic inflammation was 42% (93/219 samples); proven intra-amniotic infection was detected only in 23% (50/219 samples). Intra-amniotic inflammation with a negative amniotic fluid culture for micro-organisms was found in 23% (51/219 samples) and was as common as proven intra-amniotic infection. Pregnancy outcome was worse in patients with intra-amniotic inflammation and a negative culture than in those patients with a negative culture and without inflammation. There were no differences in the interval-to-delivery or rate of complications between patients with intra-amniotic inflammation and a negative culture and patients with proven amniotic fluid infection.

CONCLUSION:

We conclude that intra-amniotic inflammation, regardless of culture result, is present in 42% of patients with preterm premature rupture of the membranes and that it is a risk factor for impending preterm delivery and adverse outcome. We propose that intra-amniotic inflammation, rather than infection, be used to classify and treat patients with preterm premature rupture of the membranes.

• Authors: Soon-Sup Shim, Roberto Romero, Joon-Seok Hong, Chan-Wook Park, Jong Kwan Jun, Beyong Il Kim, Bo Hyun Yoon
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 191 Issue 4 Pg. 1339-45 (Oct 2004) ISSN: 0002-9378 [Print] United States
• PMID: 15507963 (Publication Type: Journal Article)

Chemical References

• Matrix Metalloproteinase 8

Topics

• Adult
• Amniotic Fluid (microbiology)
• Chorioamnionitis (epidemiology)
• Female
• Fetal Membranes, Premature Rupture (epidemiology)
• Humans
• Infant, Newborn
• Infant, Newborn, Diseases (epidemiology)
• Matrix Metalloproteinase 8 (analysis)
• Obstetric Labor, Premature (epidemiology)
• Pregnancy
• Pregnancy Outcome (epidemiology)
• Risk Factors