667: Intra-amniotic inflammatory response elevates according to the increase in the grade of chorio-deciduitis in the context of inflammation restricted to chorio-decidua, but not inflammation in the compartments beyond chorio-decidua :‘relationship between the grade of chorio-deciduitis and intra-amniotic inflammatory response in spontaneous preterm birth’ revisited

Abstract

No information exists about whether intra-amniotic inflammatory response(IAIR) elevates according to the increase in the grade of chorio-deciduitis in the context of the early stage(i.e., inflammation restricted to chorio-decidua[CD]) or advanced stage(i.e., inflammation in the compartments beyond CD[i.e., amnion, umbilical cord(UC) or chorionic plate(CP)]) of ascending intrauterine infection(AIUI) among spontaneous preterm gestations. The objective of the study is to examine this issue. Study population included 195singleton pregnant women who had acute histologic chorioamnionitis with CD involvement and delivered within 7days of amniocentesis before 35.7weeks due to PTL or preterm-PROM. We examined IAIR according to the grade of chorio-deciduitis in the context of inflammation-free amnion, UC and CP, and inflammation restricted to CD, and in the context of amnionitis, funisitis and CP inflammation, and inflammation in the compartments beyond CD. IAIR was measured by AF MMP-8 concentration(ng/ml). 1)Amnionitis, funsitis, CP inflammation and inflammation in the compartments beyond CD were present in 52%, 52%, 37% and 69% of cases;2) Median AF MMP-8 level was significantly elevated according to the increase in the grade of chorio-deciduitis in the context of inflammation-free amnion(Fig. 1.a), UC(Fig. 1.b) and CP(Fig. 1.c), and inflammation restricted to CD(Fig. 1.d);3) However, there was no significant difference in the median AF MMP-8 level between patients with grade 1 and grade 2 of chorio-deciduitis in the context of amnionitis(Fig. 2.a), funsitis(Fig. 2.b), CP inflammation(Fig. 2.c) and inflammation in the compartments beyond CD(Fig. 2.d). IAIR elevates according to the increase in the grade of chorio-deciduitis in the context of inflammation restricted to CD, but not inflammation in the compartments beyond CD. This finding suggests that the grade of chorio-deciduitis may have no effect on the intensification of IAIR in the context of inflammation in the compartments beyond CD among patients at risk for spontaneous preterm birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)