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The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency
Cited 128 time in
Web of Science
Cited 152 time in Scopus
- Authors
- Issue Date
- 2008-03-18
- Publisher
- Elsevier
- Citation
- Am J Obstet Gynecol. 2008;198(6):633.e1-633.e8
- Keywords
- Adult ; Amniotic Fluid/immunology/*microbiology ; Chorioamnionitis/*epidemiology/immunology ; Female ; Fetal Membranes, Premature Rupture/*immunology ; Gestational Age ; Humans ; Matrix Metalloproteinase 8/*analysis ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Risk Factors ; Uterine 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
https://hdl.handle.net/10371/68084
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