Abstract
ObjectiveCervical length measurement has been uggested as a useful tool for predicting intra-amniotic infection/inflammation in preterm labor, but little information is available in the setting of preterm premature rupture of membranes (pPROM). We aimed to determine whether a short cervical length is independently associated with an increased risk of intra-amniotic infection or inflammation and impending preterm delivery in women with pPROM.MethodsThis was a retrospective cohort study involving 171 consecutive singleton pregnant women with pPROM (21+0–33+6 weeks’ gestation), who underwent amniocentesis. Amniotic fluid (AF) was cultured, and assayed for interleukin (IL)-6 and IL-8. Cervical length was measured at the time of amniocentesis by transvaginal ultrasonography with an aseptic technique. Short cervical length was defined as a cervical length of ≤15 mm. Intra-amniotic infection was defined as a positive AF culture for microorganisms and intra-amniotic inflammation was defined as elevated AF concentrations of IL-6 or IL-8 (IL-6 ≥1.5 ng/mL and/or IL-8 ≥1.3 ng/mL).ResultsFifty (29.2%) women had a sonographic cervical length of ≤15mm. On univariate analysis, short cervical length was associated with an increased risk for intra-amniotic infection and/or inflammation; no other parameters studied showed a significant association. Multivariable analyses indicated that short cervical length was significantly associated with a higher risk of impending preterm delivery (within 2 days of measurement, within 7 days of measurement, and before 34 weeks), and remained significant after adjustment for potential confounders.ConclusionIn women with pPROM, short cervical length is associated with an increased risk for intra-amniotic infection/inflammation and associated with impending preterm delivery, independent of the presence of intra-amniotic infection/inflammation.
Highlights
Preterm premature rupture of membranes is a precursor in approximately onethird of preterm deliveries, and is associated with significant perinatal mortality and morbidity [1, 2]
Multivariable analyses indicated that short cervical length was significantly associated with a higher risk of impending preterm delivery, and remained significant after adjustment for potential confounders
It is unclear if the increased risk of impending preterm delivery in premature rupture of membranes (pPROM) associated with a short cervix is related to the presence of intra-amniotic infection/inflammation, as intra-amniotic infection/inflammation carries a higher risk of preterm delivery
Summary
Preterm premature rupture of membranes (pPROM) is a precursor in approximately onethird of preterm deliveries, and is associated with significant perinatal mortality and morbidity [1, 2]. Cervical length has been suggested as a useful tool for predicting intra-amniotic infection/inflammation in preterm labor [11, 12]. To date, there is a paucity of information regarding the significance of a short cervix in pPROM in terms of intra-amniotic infection/ inflammation It is unclear if the increased risk of impending preterm delivery in pPROM associated with a short cervix is related to the presence of intra-amniotic infection/inflammation, as intra-amniotic infection/inflammation carries a higher risk of preterm delivery. These issues are important because early diagnosis of such conditions in the initial evaluation of pPROM patients is possible by measuring cervical length with a noninvasive and rapid technique
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