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The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency

Cited 113 time in Web of Science Cited 120 time in Scopus
Authors
Lee, Si Eun; Romero, Roberto; Park, Chan-Wook; Jun, Jong Kwan; Yoon, Bo Hyun
Issue Date
2008-03-18
Publisher
Elsevier
Citation
Am J Obstet Gynecol. 2008;198(6):633.e1-633.e8
Keywords
AdultAmniotic Fluid/immunology/*microbiologyChorioamnionitis/*epidemiology/immunologyFemaleFetal Membranes, Premature Rupture/*immunologyGestational AgeHumansMatrix Metalloproteinase 8/*analysisObstetric Labor, PrematurePregnancyPregnancy OutcomeRisk FactorsUterine Cervical Incompetence/*microbiology
Abstract
OBJECTIVE: The purpose of this study was to determine the frequency and clinical significance of intraamniotic inflammation in patients with acute cervical insufficiency. STUDY DESIGN: Amniocentesis was performed in 52 patients with acute cervical insufficiency (cervical dilation, > or =1.5 cm) and intact membranes and without regular uterine contractions (gestational age, 17-29 weeks). Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8. Intraamniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 concentration (>23 ng/mL). Nonparametric statistics and survival techniques were used for analysis. RESULTS: The prevalence of intraamniotic inflammation was 81% (42/52); the prevalence of a positive AF culture was 8% (4/52). Intraamniotic inflammation was present in all cases with a positive AF culture. Preterm delivery within 7 days occurred in 50% of cases (19/38), and delivery before 34 weeks of gestation occurred in 84% of cases (32/38) with intraamniotic inflammation but without AF infection. Fifty-five percent of newborn infants (21/38) who were born to mothers with intraamniotic inflammation but without AF infection died immediately after birth (<1 day). The amniocentesis-to-delivery interval was shorter in patients with intraamniotic inflammation than in those without inflammation (P < .05). There were no differences in the interval-to-delivery or the rate of adverse outcome between patients with intraamniotic inflammation and a negative culture and patients with proven AF infection. CONCLUSION: Intraamniotic inflammation, regardless of AF culture result, is present in approximately 80% of patients with acute cervical insufficiency and is a risk factor for impending preterm delivery and adverse outcomes.
ISSN
1097-6868 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18342290

http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6W9P-4S26RVC-1-5&_cdi=6688&_user=168665&_orig=search&_coverDate=06%2F30%2F2008&_sk=998019993&view=c&wchp=dGLbVtb-zSkWA&md5=732541218cf3322a8678de374d6caeaa&ie=/sdarticle.pdf

http://hdl.handle.net/10371/68084
DOI
https://doi.org/10.1016/j.ajog.2007.11.047
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College of Medicine/School of Medicine (의과대학/대학원)Obstetrics & Gynecology (산부인과전공)Journal Papers (저널논문_산부인과학전공)
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