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J Perinat Med. 2019 Jul 26;47(5):516-527. doi: 10.1515/jpm-2019-0003.

The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species.

Oh KJ1,2, Romero R3,4,5,6, Park JY1,2, Hong JS1,2, Yoon BH1.

Author information

1
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
2
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-Si, Korea.
3
Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA, andDetroit, MI, USA.
4
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
5
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
6
Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.

Abstract

Objectives To determine the relationship between the intensity of the intra-amniotic inflammatory response and the gestational age at the time of diagnosis in cases with preterm premature rupture of membranes (PROM) and intra-amniotic infection caused by Ureaplasma spp. Methods A retrospective cohort study was conducted which included 71 women with preterm PROM and a positive amniotic fluid culture with Ureaplasma spp. Women with mixed intra-amniotic infections were excluded. The study population was classified into three groups according to gestational age: group 1, <26 weeks (extreme preterm PROM, n = 17); group 2, 26.0-33.9 weeks (moderate preterm PROM, n = 39); group 3, 34.0-36.9 weeks (late preterm PROM, n = 15). The intensity of the intra-amniotic and maternal inflammatory response was compared among the three groups. The intensity of the intra-amniotic inflammatory response was assessed by the concentration of amniotic fluid matrix metalloproteinase-8 (MMP-8) and white blood cell (WBC) count. The maternal inflammatory response was assessed by the concentration of C-reactive protein (CRP) and WBC count in maternal blood at the time of amniocentesis. Results (1) The median values of amniotic fluid MMP-8 concentration and WBC count were the highest in the extreme preterm PROM group and the lowest in the late preterm PROM group (P < 0.001 and P = 0.01, respectively); (2) the intensity of the maternal inflammatory response measured by maternal blood WBC count and CRP concentration was not significantly associated with gestational age at the time of diagnosis. Conclusion The earlier the gestational age at the time of PROM, the higher the intensity of the intra-amniotic inflammatory response in women with preterm PROM and intra-amniotic infection caused by Ureaplasma spp.

KEYWORDS:

Ureaplasma; chorioamnionitis; intra-amniotic infection; intra-amniotic inflammation; matrix metalloproteinase-8; microbial invasion of amniotic cavity; prematurity; preterm labor; preterm premature rupture of membranes

PMID:
31141489
DOI:
10.1515/jpm-2019-0003

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