INFECTION MARKERS IN PRETERM LABOR (PTL). † 1250

Abstract

Increasing evidence suggests an association between subclinical infection of the upper genital tract and PTL. To study the prevalence of infectious organisms (aerobic and anaerobic bacterias, fungi, Mycoplasmas, Ureaplasma, Chlamydia and Trichomonas) in amniotic fluid (AF) and the endocervix, inflammatory placental lesions, and the predictive value of tumor necrosis factor (TNF), IL-1, IL-6 and glucose in AF for latent period (amniocentesis to delivery interval) and preterm birth, amniocentesis and endocervical cultures were performed in 44 women with PTL (gestational age 30±3 weeks) and intact membranes. The incidence of positive cultures in AF and endocervical samples was 5 and 66%, respectively (p<0.01). Preterm birth was associated with organisms in AF in 8% (2/25, OR 1.6, CI 1.25 - 2.07). AF IL-6 was the best predictor of a latent period ≤ 7 days (cut off ≥ 100 pg/ml by receiver operator curve, ROC; sensitivity 75%, negative predictive value (NPV) 95%, area under the curve (AUC) 0.66±0.08, p=0.058). AF glucose was the best predictor of preterm birth (cut off ≥ 37 mgl/dl by ROC; specificity 69%, positive predictive value (PPV) 75%, AUC 0.61±0.09, p=0.226)(table). 68% of the placentas had acute inflammatory changes. Our results demonstrate an infrequent association between preterm labor and organisms in AF. However, the rate of positive endocervical cultures, elevated AF IL-6 levels, and inflammatory placental changes suggest that infection contributes to preterm labor. AF glucose and IL-6 levels may be useful to predict latent period and preterm birth.