Prediction of pregnancy outcome in preterm premature rupture of membranes using vaginal pool amniotic fluid markers

Abstract

Objective: To determine whether there is an association between levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), and glucose in vaginal pool amniotic fluid specimens and pregnancy outcome in preterm premature rupture of membranes (PPROM). Methods: Vaginal pool amniotic fluid samples from 49 patients at between 27 and 36 weeks of gestation with PPROM and no evidence of clinical chorioamnionitis were tested for IL-6, LDH, and glucose. Results were compared with respect to collection-to-delivery interval, histologic chorioamnionitis, and neonatal sepsis. Results: The mean collection-to-delivery interval was 67 hours (3 to 420 hours). There was no difference between IL-6, LDH, or glucose with respect to collection-to-delivery interval. The prevalence of histologic chorioamnionitis was 36% (18 of 49). The prevalence of neonatal sepsis was 26% (13 of 49); six of the 13 also had histologic chorioamnionitis. The mean LDH level was significantly greater (107.6 U/L) for women with histologic chorioamnionitis than for those without (9.8 U/L; P = 0.0004). A receiver operating curve found that an LDH level greater than 25 U/L predicted histologic chorioamnionitis (PPV, 80%). Conclusion: Vaginal pool amniotic fluid LDH greater than 25 U/L was shown to predict histologic chorioamnionitis in PPROM, whereas IL-6 and glucose were not shown to be clinically useful.