124: Does intra-amniotic inflammation influence pregnancy outcome after cerclage or progesterone (17OHP-C) therapy for midtrimester short cervix?

Abstract

• Many, but not all, patients with mid-trimester short cervix (≤25mm) have elevated levels of cytokines. However, most studies have only examined one or two cytokines at a time. • We propose a novel amniotic fluid (AF) cytokine score based on a comprehensive cytokine analysis of patients with midtrimester short cervix. OBJECTIVE: We propose a novel amniotic fluid (AF) cytokine score based on a comprehensive cytokine analysis of patients with mid-trimester short cervix. STUDY DESIGN: AF was collected from singleton gestations (n=44) with a cervical length of ≤25mm at 16-24 weeks gestation and assayed for 25 cytokines simultaneously using the Bio-PlexTM system. Univariate and regression analyses identified which mediators were detected in substantial quantities and predictive of delivery. The distribution of the inflammatory score, clinical characteristics, and delivery outcome are reported. RESULTS: Univariate analysis identified 13 cytokines that were undetected in at least 25% of patients. Patients were assigned 1 point for each of these cytokines if their level was >2 times the level of detection. Levels of IL-6, IL-8, G-CSF, Interferon-γ, MCP-1, MIP-1β, or RANTES in the upper quartile were predictive of delivery. Patients were assigned 1 point for each of these cytokines in the upper quartile. 5 cytokines were detected in almost all patients, but were not predictive of delivery. These were not included in the inflammatory score. The inflammatory score ranged from 0-20 and was bimodally distributed (Figure1). Patients with a score <10 (n=18) had a shorter cervical length and delivered significantly earlier (Table 2, P<0.001 for each, Wilcoxon). A score ≥10 had a 77% sensitivity, 100% specificity, 100%PPV, 81%NPV for delivery <32 weeks. CONCLUSION: A cytokine inflammatory score is related to delivery outcome & clinical characteristics. If shown to be predictive in future studies, this score may aid in choosing therapies based on the presence or absence of inflammation.