Abstract
ObjectiveTo characterize subgroups of preterm prelabor rupture of membranes (PPROM) and short-term neonatal outcomes based on the presence and absence of intraamniotic inflammation (IAI) and/or microbial invasion of the amniotic cavity (MIAC).MethodsOne hundred and sixty-six Caucasian women with singleton pregnancies were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis (n=166) and were assayed for interleukin-6 levels by a lateral flow immunoassay. The presence of Ureaplasma species, Mycoplasma hominis, Chlamydia trachomatis, and 16S rRNA was evaluated in the amniotic fluid. IAI was defined as amniotic fluid IL-6 values, measured by a point of care test, higher than 745 pg/mL.ResultsMicrobial-associated IAI (IAI with MIAC) and sterile intraamniotic inflammation (IAI alone) were found in 21% and 4%, respectively, of women with PPROM. Women with microbial-associated IAI had higher microbial loads of Ureaplasma species in the amniotic fluid than women with MIAC alone. No differences in the short-term neonatal morbidity with respect to the presence of microbial-associated IAI, sterile IAI and MIAC alone were found after adjusting for the gestational age at delivery in women with PPROM.ConclusionsMicrobial-associated but not sterile intraamniotic inflammation is common in Caucasian women with PPROM. The gestational age at delivery but not the presence of inflammation affects the short-term neonatal morbidity of newborns from PPROM pregnancies.
Highlights
Preterm prelabor rupture of membranes (PPROM) is defined as a rupture of fetal membranes with leakage of amniotic fluid prior to 37 weeks of gestation
No differences in the short-term neonatal morbidity with respect to the presence of microbial-associated IAI, sterile IAI and microbial invasion of the amniotic cavity (MIAC) alone were found after adjusting for the gestational age at delivery in women with PPROM
Microbial-associated but not sterile intraamniotic inflammation is common in Caucasian women with PPROM
Summary
Preterm prelabor rupture of membranes (PPROM) is defined as a rupture of fetal membranes with leakage of amniotic fluid prior to 37 weeks of gestation. The presence of a small amount of bacteria with a low virulent potential, such Ureaplasma species, in the amniotic is unlikely to elicit IAI and be associated with worse pregnancy and neonatal outcomes This scenario is considered colonization of the amniotic fluid [15]. Some endogenous mediators called alarmins (e.g., high mobility group box-1 protein) are released into the amniotic fluid and can trigger intraamniotic inflammation through the same system of pattern recognition receptors as in the infectious scenario [5,16] This leads to the development of sterile IAI (the presence of IAI without any proven microorganism in the amniotic fluid)
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