S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Ph.D. / Sc.D._의학과)
The frequency and association of intra-amniotic inflammation with perinatal outcome in twin pregnancies with preterm labor and intact membranes
조기진통을 동반한 쌍태임신에서 양수내 염증의 빈도 및 주산기 예후와의 관련성
- Kyung Joon Oh
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- intra-amniotic inflammation; intra-amniotic infection; preterm labor; preterm birth; twin pregnancy
- 학위논문 (박사)-- 서울대학교 대학원 : 의학과 산부인과학 전공, 2016. 8. 윤보현.
Twin pregnancies have a six-fold higher perinatal mortality compared with singleton pregnancies. Preterm delivery is the major cause of perinatal mortality and morbidity in twin pregnancies. The frequency of intra-amniotic inflammation (IAI) reaches 30% of singleton pregnancies with preterm labor and intact membranes. Moreover, IAI alone (regardless of the presence or absence of proven intra-amniotic infection) is a risk factor for the progression of labor to preterm delivery and adverse outcome. The purpose of this study was to evaluate the frequency and association of IAI with perinatal outcome in twin pregnancies with preterm labor.
Amniotic fluid (AF) was retrieved from both sacs in 90 twin gestations with preterm labor and intact membranes (gestational age between 20+0 and 34+6 weeks). Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 (MMP-8). Microbial invasion of amniotic cavity (MIAC) was diagnosed in cases with a positive AF culture. IAI was defined as an AF MMP-8 concentration >23 ng/mL. Study population was divided into 3 groups according to the results of AF analysis: group 1, cases without IAI or MIAC (n=55)
group 2, cases without MIAC but with IAI of at least 1 amniotic cavity (n=26)
group 3, cases with IAI and MIAC of at least 1 amniotic cavity (n=9). Non-parametric and survival techniques were used for analysis. Multiple logistic analysis and generalized estimation equation models were used to adjust important confounding variables.
1) The rate of IAI of at least 1 amniotic cavity was 39% (35/90), among which IAI with MIAC was detected in 10% (9/90), and IAI without MIAC was found in 29% (26/90)
2) IAI was present in both sacs in 22 cases, in the presenting sac in 12 cases, and in the non-presenting sac in 1 case
3) AF culture was positive in both sacs in 6 cases and in the presenting sac in 3 cases
4) Women without MIAC but with IAI of at least 1 amniotic cavity (group 2) had a significantly higher rate of adverse outcome (a lower gestational age at delivery, shorter amniocentesis-to-delivery interval, and neonatal death and/or any significant morbidity) than those without IAI or MIAC (group 1). There was no significant difference in pregnancy outcomes between women without MIAC but with IAI of at least 1 amniotic cavity (group 2) and those with IAI and MIAC of at least 1 amniotic cavity (group 3).
1) IAI is present in 39% of twin pregnancies with preterm labor and intact membranes and is a risk factor for impending preterm delivery and adverse outcome. 2) IAI was found more frequently in the presenting sac than in the non-presenting sac, which supports the view that the ascending route is the common pathway of intra-amniotic infection/inflammation.