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.
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: Charles J Lockwood; William K Murk; Umit A Kayisli; Lynn F Buchwalder; S Joseph Huang; Felice Arcuri; Min Li; Arun Gopinath; Frederick Schatz Journal: Am J Pathol Date: 2010-08-19 Impact factor: 4.307
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Authors: Seung Mi Lee; Roberto Romero; Jeong Woo Park; Sun Min Kim; Chan-Wook Park; Steven J Korzeniewski; Tinnakorn Chaiworapongsa; Bo Hyun Yoon Journal: J Matern Fetal Neonatal Med Date: 2012-04-25
Authors: Daniel B DiGiulio; Roberto Romero; Juan Pedro Kusanovic; Ricardo Gómez; Chong Jai Kim; Kimberley S Seok; Francesca Gotsch; Shali Mazaki-Tovi; Edi Vaisbuch; Katherine Sanders; Elisabeth M Bik; Tinnakorn Chaiworapongsa; Enrique Oyarzún; David A Relman Journal: Am J Reprod Immunol Date: 2010-03-21 Impact factor: 3.886
Authors: R Romero; J Espinoza; F Gotsch; J P Kusanovic; L A Friel; O Erez; S Mazaki-Tovi; N G Than; S Hassan; G Tromp Journal: BJOG Date: 2006-12 Impact factor: 6.531