C Andrew Combs1, Michael Gravett2, Thomas J Garite3, Durlin E Hickok4, Jodi Lapidus5, Richard Porreco6, Julie Rael7, Thomas Grove4, Terry K Morgan5, William Clewell8, Hugh Miller9, David Luthy10, Leonardo Pereira5, Michael Nageotte11, Peter A Robilio2, Stephen Fortunato12, Hyagriv Simhan13, Jason K Baxter14, Erol Amon15, Albert Franco16, Kenneth Trofatter17, Kent Heyborne6. 1. Center for Research, Education, and Quality, Mednax, Inc., Sunrise, FL; Obstetrix Medical Group, San Jose, CA. 2. University of Washington Medical Center, Seattle, WA. 3. Center for Research, Education, and Quality, Mednax, Inc., Sunrise, FL. 4. ProteoGenix, Inc., Costa Mesa, CA. 5. Oregon Health and Science University, Portland, OR. 6. Obstetrix Medical Group of Colorado, Denver, CO. 7. Center for Research, Education, and Quality, Mednax, Inc., Sunrise, FL; Obstetrix Medical Group of Colorado, Denver, CO. 8. Obstetrix Medical Group, Phoenix Perinatal Associates, Phoenix, AZ. 9. Obstetrix Medical Group of Arizona, Tucson, AZ. 10. Obstetrix Medical Group of Washington, Seattle, WA. 11. Obstetrix Medical Group, Southern California, Long Beach, CA. 12. Perinatal Research Group, Nashville, TN. 13. University of Pittsburgh, Pittsburgh, PA. 14. Thomas Jefferson University, Philadelphia, PA. 15. St. Louis University School of Medicine, St. Louis, MO. 16. Carolinas Medical Center, Charlotte, NC. 17. University Medical Center, Greenville, SC.
Abstract
OBJECTIVE: The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as predictors of adverse outcome in preterm labor with intact membranes. STUDY DESIGN: Interleukin-6 (IL-6) was measured in prospectively collected amniotic fluid from 305 women with preterm labor. MIAC was defined by amniotic fluid culture and/or detection of microbial 16S ribosomal DNA. Cases were categorized into 5 groups: infection (MIAC; IL-6, ≥11.3 ng/mL); severe inflammation (no MIAC; IL-6, ≥11.3 ng/mL); mild inflammation (no MIAC; IL-6, 2.6-11.2 ng/mL); colonization (MIAC; IL-6, <2.6 ng/mL); negative (no MIAC; IL-6, <2.6 ng/mL). RESULTS: The infection (n = 27) and severe inflammation (n = 36) groups had similar latency (median, <1 day and 2 days, respectively) and similar rates of composite perinatal morbidity and mortality (81% and 72%, respectively). The colonization (n = 4) and negative (n = 195) groups had similar outcomes (median latency, 23.5 and 25 days; composite morbidity and mortality rates, 21% and 25%, respectively). The mild inflammation (n = 47) groups had outcomes that were intermediate to the severe inflammation and negative groups (median latency, 7 days; composite morbidity and mortality rates, 53%). In logistic regression adjusting for gestational age at enrollment, IL-6 ≥11.3 and 2.6-11.2 ng/mL, but not MIAC, were associated significantly with composite morbidity and mortality rates (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.2-11.2, OR, 3.1; 95% CI, 1.5-6.4, and OR, 1.8; 95% CI, 0.6-5.5, respectively). CONCLUSION: We confirmed previous reports that intraamniotic inflammation is associated with adverse perinatal outcomes whether or not intraamniotic microbes are detected. Colonization without inflammation appears relatively benign. Intraamniotic inflammation is not simply present or absent but also has degrees of severity that correlate with adverse outcomes. We propose the designation amniotic inflammatory response syndrome to denote the adverse outcomes that are associated with intraamniotic inflammation.
OBJECTIVE: The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as predictors of adverse outcome in preterm labor with intact membranes. STUDY DESIGN:Interleukin-6 (IL-6) was measured in prospectively collected amniotic fluid from 305 women with preterm labor. MIAC was defined by amniotic fluid culture and/or detection of microbial 16S ribosomal DNA. Cases were categorized into 5 groups: infection (MIAC; IL-6, ≥11.3 ng/mL); severe inflammation (no MIAC; IL-6, ≥11.3 ng/mL); mild inflammation (no MIAC; IL-6, 2.6-11.2 ng/mL); colonization (MIAC; IL-6, <2.6 ng/mL); negative (no MIAC; IL-6, <2.6 ng/mL). RESULTS: The infection (n = 27) and severe inflammation (n = 36) groups had similar latency (median, <1 day and 2 days, respectively) and similar rates of composite perinatal morbidity and mortality (81% and 72%, respectively). The colonization (n = 4) and negative (n = 195) groups had similar outcomes (median latency, 23.5 and 25 days; composite morbidity and mortality rates, 21% and 25%, respectively). The mild inflammation (n = 47) groups had outcomes that were intermediate to the severe inflammation and negative groups (median latency, 7 days; composite morbidity and mortality rates, 53%). In logistic regression adjusting for gestational age at enrollment, IL-6 ≥11.3 and 2.6-11.2 ng/mL, but not MIAC, were associated significantly with composite morbidity and mortality rates (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.2-11.2, OR, 3.1; 95% CI, 1.5-6.4, and OR, 1.8; 95% CI, 0.6-5.5, respectively). CONCLUSION: We confirmed previous reports that intraamniotic inflammation is associated with adverse perinatal outcomes whether or not intraamniotic microbes are detected. Colonization without inflammation appears relatively benign. Intraamniotic inflammation is not simply present or absent but also has degrees of severity that correlate with adverse outcomes. We propose the designation amniotic inflammatory response syndrome to denote the adverse outcomes that are associated with intraamniotic inflammation.
Authors: Roberto Romero; Jezid Miranda; Juan P Kusanovic; Tinnakorn Chaiworapongsa; Piya Chaemsaithong; Alicia Martinez; Francesca Gotsch; Zhong Dong; Ahmed I Ahmed; Majid Shaman; Kia Lannaman; Bo Hyun Yoon; Sonia S Hassan; Chong J Kim; Steven J Korzeniewski; Lami Yeo; Yeon Mee Kim Journal: J Perinat Med Date: 2015-01 Impact factor: 1.901
Authors: Matthew Josiah Allen-Daniels; Myrna G Serrano; Lindsey P Pflugner; Jennifer M Fettweis; Melissa A Prestosa; Vishal N Koparde; J Paul Brooks; Jerome F Strauss; Roberto Romero; Tinnakorn Chaiworapongsa; David A Eschenbach; Gregory A Buck; Kimberly K Jefferson Journal: Am J Obstet Gynecol Date: 2015-01-28 Impact factor: 8.661
Authors: Roberto Romero; Piya Chaemsaithong; Steven J Korzeniewski; Juan P Kusanovic; Nikolina Docheva; Alicia Martinez-Varea; Ahmed I Ahmed; Bo Hyun Yoon; Sonia S Hassan; Tinnakorn Chaiworapongsa; Lami Yeo Journal: J Perinat Med Date: 2016-01 Impact factor: 1.901