Amniotic fluid C-reactive protein as a predictor of infection in caesarean section: a feasibility study

Zbigniew Marchocki,Keelin O'Donoghue,Angela Vinturache,Paddy O' Reilly,Kevin Collins

doi:10.1038/s41598-018-24569-8

Zbigniew Marchocki, Keelin O'Donoghue + Show 3 more

Open Access

https://doi.org/10.1038/s41598-018-24569-8

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Abstract

This study evaluated the feasibility of maternal C-reactive protein (CRP) in amniotic fluid (AF) as a predictor of post-partum infection in women who undergo emergency or elective caesarean section (CS). AF bacterial culture and levels of hs-CRP in maternal serum and AF were evaluated in Day 0 and three days thereafter (Day 3) in 79 women undergoing CS. Univariate analyses assessed the clinical and demographic characteristics, whereas the ROC curves assessed the feasibility of hs-CRP as marker of inflammation in women who undergo CS. There was no difference in AF, Day 0, and Day 3 serum hs-CRP levels between women with sterile compared to those with bacterial growth in AF. Among women with positive AF cultures, AF and Day 0 serum hs-CRP levels were higher in women who underwent emergency compared to those who had elective CS (p = 0.04, and p = 0.02 respectively). hs-CRP in Day 0 and Day 3 serum but not in AF has a fair predictor value of infection in emergency CS only (AUC 0.767; 95% CI 0.606–0.928, and AUC 0.791; 95% CI 0.645–0.036, respectively). We conclude that AF hs-CRP is not feasible in assessing the risk of post-cesarean inflammation or infection.

Highlights

The proportion of births delivered by caesarean section (CS) has increased worldwide significantly over the past three decades, currently approximately 18.6% of pregnancies being delivered by CS1
This study evaluated the propensity of amniotic fluid (AF) hs-C-reactive protein (CRP) in predicting CS-associated infection and inflammation
By using Receiver Operator Curve (ROC) plot analysis, our findings suggest that AF high sensitivity CRP (hs-CRP) does not predict inflammation in women who deliver by CS, whereas serum hs-CRP appears to be a better predictor of inflammation/infection in emergency than in elective CS

Summary

Introduction

The proportion of births delivered by caesarean section (CS) has increased worldwide significantly over the past three decades, currently approximately 18.6% of pregnancies being delivered by CS1. It is estimated that postoperative rates of infection after CS range between 1.2 and 5.0% for women during their inpatient stay[8,10,11,12]. Most frequent infectious complications following cesarean birth include fever (febrile morbidity), skin and soft tissue infection (wound infection), endometritis (inflammation of the lining of the uterus), and urinary tract infection which occur in 8% of women. With the increase in CS rates worldwide, it is anticipated that related infections will become an increasing health and economic burden[1,13], through their associated morbidity, increased hospital stay or re-admission after delivery[13]. Factors associated with an increased risk of infection in women after CS include emergency procedures, duration of labor, ruptured membranes, vaginal examination in labor, internal fetal monitoring, obesity, blood loss and operative technique[1,13]. There have been no recent studies performed on the use of amniotic fluid (AF) markers as predictors of postoperative infectious morbidity post CS in term pregnancies

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