Abstract
Objectives. Our objective is to compare maternal plasma procalcitonin concentrations in preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term with their levels in uncomplicated pregnancy, and to determine whether these concentrations are useful in the diagnosis of pPROM cases suspected of infection and in the prediction of pPROM-to-delivery interval. Study design. Forty eight patients with pPROM, 30 with PROM at term, 31 healthy women at preterm gestation, and 33 healthy women at term were included. In pPROM group, analysis of procalcitonin concentrations with reference to leucocytosis, serum C-reactive protein, vaginal fluid culture, neonatal infection, histological chorioamnionitis and pPROM-to-delivery interval was carried out. Results. Procalcitonin concentrations in pPROM and PROM at term cases were comparable. However, in both groups procalcitonin values were significantly higher than in healthy controls in approximate gestational age. In pPROM group, procalcitonin concentrations between the patients with and without laboratory indices of infection were comparable, as well as between patients who gave birth to newborns with and without congenital infection, and between patients with and without histological chorioamnionitis. The predictive values of procalcitonin determinations were poor. Conclusion. The value of maternal plasma procalcitonin determinations in the diagnostics of pPROM cases suspected of intraamniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, procalcitonin concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnants, and therefore further evaluations are necessary to establish the role of procalcitonin in the pathophysiology of pregnancy.
Highlights
The management of a patient who presents with preterm premature rupture of membranes is controversial and remains a challenging task in perinatal medicine
The pregnancies complicated by premature rupture of membranes (pPROM) were subjected to particulary careful analyses
Laboratory indices suggesting the presence of subclinical intraamniotic infection (IAI) were searched by evaluating white blood cell count (WBC) count, C-reactive protein (CRP) concentration, and vaginal fluid culture, in these cases no clinical signs of infection were found (Table 3)
Summary
The management of a patient who presents with preterm premature rupture of membranes (pPROM) is controversial and remains a challenging task in perinatal medicine. In women without signs of infection, the current standard of care is hospitalization and bed rest until there is evidence of ascending infection or documentation of fetal lung maturity [3, 4]. Primary intraamniotic subclinical infection is one of the main causes of pPROM and the early identification of such cases is necessary for choosing the proper mode of management [3, 5]. Several studies have demonstrated that fetal compromise can be suspected by measuring inflammatory mediators in amniotic fluid or in cervicovaginal secretion, and in the maternal blood
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have