Abstract
Introduction: Preterm prelabor rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labor pains, before 37 completed weeks of gestation. Chorioamnionitis (CAM) affects many pregnancies complicated by PPROM. Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes. It has been claimed that estimation of C-reactive proteins (CRP) is helpful in the diagnosis of chorioamnionitis, and this study aims to appraise such claimsObjective: To determine the diagnostic accuracy of C-reactive protein in the detection of chorioamnionitis in women with PPROM and to test sensitivity/specificity/positive predictive valve/negative predictive value of CRP in diagnosing chorioamnionitis against histopathological examination of placenta.Method: A study conducted on total 440 antenatal women, 220 cases of PROM and 220 cases with same gestation but without PPROM used as a control. A detailed obstetrical and menstrual history was taken and systemic and local examination was done. Subjects were managed expectantly with use of tocolytics, antibiotics and steroids. Frequent vital signs monitoring and hematological investigation were done. CRP levels were determined. After delivery placenta was sent for histopathological examination for the presence of chorioamnionitis.Results: CRP appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infection. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (45.45%) in identifying chorioamnionitis. The positive predictive value was 31.4% and negative predictive value was 100%.Conclusion: CRP is early and reliable indicator of histopathological and clinical chorioamnionitis in comparison of TLC and clinical parameter. Thus CRP can prove useful markers in identify early and subclinical infection which could lead to premature rupture of membrane.Key-words- Preterm birth, C-reactive protein, PPROM, Chorioamnionitis.
Highlights
Preterm prelabour rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labour pains, before 37 completed weeks of gestation
Chorioamnionitis (CAM) affects many pregnancies complicated by PPROM
It has been claimed that estimation of C-reactive proteins (CRP) is helpful in the diagnosis of chorioamnionitis, and this study aims to appraise such claims Objective: To determine the diagnostic accuracy of C-reactive protein in the detection of chorioamnionitis in women with PPROM and to test sensitivity/specificity/positive predictive valve/negative predictive value of CRP in diagnosing chorioamnionitis against histopathological examination of placenta
Summary
Preterm prelabour rupture of the membranes (PPROM) refers to spontaneous rupture of membranes in the absence of labour pains, before 37 completed weeks of gestation. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (45.45%) in identifying chorioamnionitis. CRP can prove useful markers in identify early and subclinical infection which could lead to premature rupture of membrane. Pathogens largely arise from the ascending route and the endogenous vaginal flora, and may cause chorioamnionitis[1].The incidence of PPROM is variable between 2-4.5% of all deliveries. It is responsible for 30% of preterm deliveries and contributes around 10% of perinatal mortality. Acute chorioamnionitis is a threat to both mother and fetus.2There are various serologic and amniotic fluid tests that may identify activation of the host immune and inflammatory responses as a consequence of the microbial invasion of the amniotic cavity, but these are not yet fully confirmed for clinical use.[3,4,5] Examples are C-
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