title: Amniotic fluid matrix metalloproteinase-8 in preterm labor with intact membranes.
abstract: OBJECTIVE
  Intra-amniotic inflammation is a major determinant of maternal and neonatal outcome in patients with preterm labor. Matrix metalloproteinase-8 is a sensitive marker of inflammation in body fluids. This study was conducted to examine the value of amniotic fluid matrix metalloproteinase-8 determinations in patients with preterm labor and intact membranes.
  
  
  METHODS
  Amniotic fluid was obtained by transabdominal amniocentesis from 371 patients with preterm labor. Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Amniotic fluid analysis included Gram stain examination, white blood cell count, and matrix metalloproteinase-8 (enzyme-linked immunosorbent assay) determination. Nonparametric statistics were used for analysis.
  
  
  RESULTS
  The rate of preterm delivery was 54% (200/371) and that of intra-amniotic infection was 9.2% (34/371). The median amniotic fluid matrix metalloproteinase-8 concentration was more than 50-fold higher in patients with intra-amniotic infection than in patients with no intra-amniotic infection (median, 605.6 ng/mL; range, 0.65-15,000 ng/mL vs median, 10.6 ng/mL; range, <0.06-16,600 ng/mL, respectively; P <.0001). The matrix metalloproteinase-8 amniotic fluid concentrations were significantly higher in patients who delivered preterm than in patients who delivered at term (median, 19.5 ng/mL; range, <0.06-16,600 ng/mL vs median, 2.1 ng/mL; range, <0.06-500 ng/mL, respectively; P <.001). After exclusion of patients with intra-amniotic infection, patients who delivered preterm had a significantly higher median amniotic fluid matrix metalloproteinase-8 than patients who delivered at term (P <.05). An amniotic fluid matrix metalloproteinase-8 level of >30 ng/mL was an independent predictor for the occurrence of neonatal morbidity (odds ratio, 3.4; 95% CI, 1.9-5.8; P <.01).
  
  
  CONCLUSIONS
  Increased amniotic fluid matrix metalloproteinase-8 concentrations identify patients at risk for intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome.
authors.affiliation: Perinatology Research Branch, National Institute of Child Health and Human Development, Bethesda, Md, USA.
authors.forename: E
authors.initials: E
authors.lastname: Maymon
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: T
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: S
authors.initials: S
authors.lastname: Berman
authors.forename: G
authors.initials: G
authors.lastname: Conoscenti
authors.forename: R
authors.initials: R
authors.lastname: Gomez
authors.forename: S
authors.initials: S
authors.lastname: Edwin
mesh_terms: D000649:Amniocentesis; D000653:Amniotic Fluid / Q000201:enzymology*; D036861:Delivery, Obstetric; D005321:Extraembryonic Membranes / Q000503:physiopathology*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000401:mortality; D007239:Infections / Q000150:complications; D020784:Matrix Metalloproteinase 8 / Q000378:metabolism*; D007752:Obstetric Labor, Premature / Q000150:complications / Q000201:enzymology* / Q000209:etiology; D009994:Osmolar Concentration; D011247:Pregnancy; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
chemical_list: D020784:Matrix Metalloproteinase 8