Characteristics of women in preterm labor associated with elevated C-reactive protein levels.
OBJECTIVE
To evaluate clinical, microbiologic, and histologic findings associated with elevated C-reactive protein levels among women in preterm labor or with preterm premature rupture of the membranes (PROM).


METHODS
Obstetric data, serum C-reactive protein levels, and amniotic fluid (AF) and chorioamniotic membrane cultures and histology were obtained on 203 women presenting between 22-34 weeks' gestation in preterm labor or with PROM.


RESULTS
Women with C-reactive protein greater than 1.5 mg/dL were more likely to deliver within 7 days of enrollment (54 of 68, 79%) than were women with normal C-reactive protein levels (45 of 135, 33%) (P < .001). The median C-reactive protein levels and association with rapid delivery did not differ between women with intact versus ruptured membranes. Elevated C-reactive protein levels were associated with a positive AF culture among women in preterm labor with intact membranes. To control for confounding by a long interval to delivery, only the group delivering within 7 days was considered for evaluation of C-reactive protein levels and placental and infant outcome. Among women delivering within 7 days, elevated C-reactive protein was associated with the development of clinical chorioamnionitis and with infant death before hospital discharge, but not with a positive membrane culture or histologic chorioamnionitis.


CONCLUSIONS
Elevated C-reactive protein appears to be associated with AF infection, delivery within 7 days of admission, and infant death among women delivering preterm, but not with membrane infection or inflammation. Elevated C-reactive protein may be helpful in determining the need for AF culture and in targeting studies of antibiotic therapy among women in preterm labor or with preterm PROM.
Department of Obstetrics and Gynecology, University of Washington, Seattle.
D H
DH
Watts
M A
MA
Krohn
S L
SL
Hillier
M H
MH
Wener
N B
NB
Kiviat
D A
DA
Eschenbach
D000653:Amniotic Fluid / Q000382:microbiology; D002097:C-Reactive Protein / Q000032:analysis*; D002821:Chorioamnionitis / Q000150:complications / Q000382:microbiology; D005321:Extraembryonic Membranes / Q000382:microbiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood* / Q000150:complications / Q000382:microbiology; D006801:Humans; D007752:Obstetric Labor, Premature / Q000097:blood* / Q000150:complications / Q000382:microbiology; D011247:Pregnancy
D002097:C-Reactive Protein