Abstract
ObjectiveTo evaluate the effect of histological chorioamnionitis (HCA) with a negative amniotic fluid (AF) culture on adverse pregnancy and neonatal outcomes and inflammatory status in the AF compartment in women with preterm labor or preterm premature rupture of membranes (PPROM).MethodsThis is a retrospective cohort study of 153 women diagnosed as having a preterm labor or PPROM (20–34 weeks) who delivered singleton gestations within 48 hours of amniocentesis. AF obtained through amniocentesis was cultured, and interleukin (IL)-6, IL-8, and metalloproteinase-9 (MMP-9) levels were determined. The placentas were examined histologically.ResultsThe prevalence of HCA with negative AF culture was 23.5% (36/153). The women with HCA but with a negative AF culture (group 2) and those with a positive AF culture (group 3) had a significantly lower mean gestational age at amniocentesis and delivery than those with a negative AF culture and without HCA (group 1). Women in group 3 had the highest levels of AF IL-6, IL-8, and MMP-9, followed by those in group 2, and those in group 1. Composite neonatal morbidity was significantly higher in groups 2 and 3 than in group 1, but this was no longer significant after adjusting for confounders caused mainly by the impact of gestational age.DiscussionIn the women who delivered preterm neonates, HCA with a negative AF culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, and prematurity-associated composite neonatal morbidity, and its risks are similar to the risk posed by positive AF culture.
Highlights
Histologic chorioamnionitis (HCA) complicates as many as 30–80% of preterm births with preterm labor or premature rupture of membranes (PPROM), and has been shown to be a risk factor of adverse maternal and neonatal outcomes, including earlier gestational age at delivery and neonatal brain and lung injuries [1,2,3,4]
In the women who delivered preterm neonates, HCA with a negative amniotic fluid (AF) culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, PLOS ONE | DOI:10.1371/journal.pone
We show that (1) among women who delivered preterm neonates owing to preterm labor or PPROM, the prevalence of HCA with a negative AF culture was 23% and that (2) similar to Birthweightf Apgar
Summary
Histologic chorioamnionitis (HCA) complicates as many as 30–80% of preterm births with preterm labor or premature rupture of membranes (PPROM), and has been shown to be a risk factor of adverse maternal and neonatal outcomes, including earlier gestational age at delivery and neonatal brain and lung injuries [1,2,3,4]. HCA is associated with the presence of microbial invasion of the amniotic cavity (MIAC), serving as a route for ascending infection, when detected in preterm placenta [5,6,7]. A substantial number of women with preterm labor or PPROM have HCA but have negative AF culture results [5, 7, 9, 10]. The purpose of this study was to determine the frequency and impact of HCA with a negative AF culture on adverse pregnancy and neonatal outcomes, and inflammatory status in the AF compartment in women with preterm labor or PPROM
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