The diagnostic and prognostic value of MMP-8 PTD check in women with preterm premature rupture of membranes

Abstract

WITH PRETERM PREMATURE RUPTURE OF MEMBRANES KUN WOO KIM, HYUN SOO PARK, SOON-SUP SHIM, JONG KWAN JUN, ROBERTO ROMERO, BO HYUN YOON, Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Seoul, South Korea, Grosse pointe, Grosse pointe, Michigan OBJECTIVE: To examine if the MMP-8 PTD Check, a rapid bedside test which can be performed in 15 minutes, is of value in the identification of intraamniotic infection/inflammation(IAI) and in the assessment of the likelihood of adverse pregnancy outcome in patients with PPROM. STUDY DESIGN: Amniotic fluid (AF) was retrieved by transabdominal amniocentesis in 105 women with PPROM (GA!35 weeks). Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas and analyzed for matrix metalloproteinase-8 (MMP-8), white blood cell (WBC) count and MMP-8 PTD Check test. IAIwasdefinedasapositiveAFculture and/orelevatedAFMMP-8 concentration (O23ng/ml). Nonparametric and survival analysis were used. RESULTS: The prevalence of IAI was 45% (47/105) and that of proven AF infection was 17% (18/105). Patients with a positive MMP-8 PTD Check test have a significantly higher rate of IAI (85% [44/52] vs 6% [3/53]; p!.001), proven AF infection (31%[16/52] vs 4%[2/53], p!.001) and adverse outcome than those with a negative MMP-8 PTD CheckTM test. Adverse outcome included shorter interval to delivery and higher rate of preterm delivery, histologic chorioamnionitis, funisitis, low Apgar scores and significant neonatal morbidity. A positive MMP-8 PTD Check test had a sensitivity of 94%, a specificity of 86%, a positive predictive value of 85% and a negative predictive value of 94% in the identification of IAI and was an independent predictor of interval to delivery (hazards ratio 4.1; 95% CI, 2.4–6.9) and significant neonatal morbidity (OR 8.2; 95% CI, 2.1–31.4). CONCLUSION: The MMP-8 PTD Check test is a rapid, simple, sensitive bedside test to detect IAI and predict adverse outcome including short latency, chorioamnionitis and significant neonatal morbidity in patients with preterm PROM. The results of this study bring the rapid detection of intra-amniotic inflammation to the bedside in clinical obstetrics.