Abstract
ObjectiveThis study evaluated maternal C-reactive protein (CRP) as a predictor of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with preterm prelabor rupture of the membranes (PPROM) before and after 32 weeks of gestation.MethodsThis study was a prospective observational cohort study of 386 women. Maternal serum CRP concentrations were evaluated, and amniotic fluid samples were obtained via transabdominal amniocentesis at the time of admission. Placentas underwent histopathological examination after delivery. MIAC was defined based on a positive PCR for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive 16S rRNA gene amplification. HCA was defined based on the Salafia classification.ResultsMaternal CRP was significantly higher in women with MIAC and HCA (median 9.0 mg/l) than in women with HCA alone (median 6.9 mg/l), MIAC alone (median 7.4 mg/l) and without MIAC or HCA (median 4.5 mg/l) (p<0.0001). CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation. Only the 95th percentile of CRP and PPROM before 32 weeks exhibited a false-positive rate of 1%, a positive predictive value of 90% and a positive likelihood ratio of 13.2 to predict MIAC and HCA. However, the low sensitivity of 15% limits the clinical utility of this detection.ConclusionCRP is a poor predictor of the occurrence of MIAC and HCA, even at early gestational ages.
Highlights
Preterm delivery is a worldwide public health problem, and it occurs in approximately 6–12% of all pregnancies [1]
Maternal C-reactive protein (CRP) was significantly higher in women with microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) than in women with HCA alone, MIAC alone and without MIAC or HCA (p
CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation
Summary
Preterm delivery is a worldwide public health problem, and it occurs in approximately 6–12% of all pregnancies [1]. Preterm prelabor rupture of membranes (PPROM) is defined as amniotic fluid leakage before 37 weeks of gestation, and it represents approximately 30–40% of all preterm deliveries. PPROM is responsible for a substantial proportion of adverse neonatal complications associated with gestational age and risk of infection [2, 3]. Microbial invasion of the amniotic cavity (MIAC) is identified in 30–40% of PPROM, at early gestational ages [4]. The presence of microorganisms activates an inflammatory response in the amniotic cavity, which is associated with early gestational age at delivery and a shorter latency to delivery [5]. HCA and funisitis are associated with neonatal composite morbidity, including chronic pulmonary disease [8] and adverse neurodevelopment outcomes [9, 10]
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