Prevalence and clinical significance of sterile intra-amniotic inflammation in patients with preterm labor and intact membranes.

Abstract

PROBLEM:

Inflammation and infection play a major role in preterm birth. The purpose of this study was to (i) determine the prevalence and clinical significance of sterile intra-amniotic inflammation and (ii) examine the relationship between amniotic fluid (AF) concentrations of high mobility group box-1 (HMGB1) and the interval from amniocentesis to delivery in patients with sterile intra-amniotic inflammation.

METHOD OF STUDY:

AF samples obtained from 135 women with preterm labor and intact membranes were analyzed using cultivation techniques as well as broad-range PCR and mass spectrometry (PCR/ESI-MS). Sterile intra-amniotic inflammation was defined when patients with negative AF cultures and without evidence of microbial footprints had intra-amniotic inflammation (AF interleukin-6 ≥ 2.6 ng/mL).

RESULTS:

(i) The frequency of sterile intra-amniotic inflammation was significantly greater than that of microbial-associated intra-amniotic inflammation [26% (35/135) versus 11% (15/135); (P = 0.005)], (ii) patients with sterile intra-amniotic inflammation delivered at comparable gestational ages had similar rates of acute placental inflammation and adverse neonatal outcomes as patients with microbial-associated intra-amniotic inflammation, and (iii) patients with sterile intra-amniotic inflammation and high AF concentrations of HMGB1 (≥8.55 ng/mL) delivered earlier than those with low AF concentrations of HMGB1 (P = 0.02).

CONCLUSION:

(i) Sterile intra-amniotic inflammation is more frequent than microbial-associated intra-amniotic inflammation, and (ii) we propose that danger signals participate in sterile intra-amniotic inflammation in the setting of preterm labor.

• Authors: Roberto Romero, Jezid Miranda, Tinnakorn Chaiworapongsa, Steven J Korzeniewski, Piya Chaemsaithong, Francesca Gotsch, Zhong Dong, Ahmed I Ahmed, Bo Hyun Yoon, Sonia S Hassan, Chong Jai Kim, Lami Yeo
• Journal: American journal of reproductive immunology (New York, N.Y. : 1989) (Am J Reprod Immunol) Vol. 72 Issue 5 Pg. 458-74 (Nov 2014) ISSN: 1600-0897 [Electronic] Denmark
• PMID: 25078709 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)
• Copyright: Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Chemical References

• HMGB1 Protein
• HMGB1 protein, human

Topics

• Adult
• Amniotic Fluid (immunology, metabolism)
• Female
• HMGB1 Protein (immunology, metabolism)
• Humans
• Inflammation (epidemiology, immunology, metabolism)
• Obstetric Labor, Premature (epidemiology, immunology, metabolism)
• Placenta (immunology, metabolism)
• Pregnancy
• Pregnancy Complications (immunology, metabolism)
• Prevalence