title: Are amniotic fluid C-reactive protein and glucose levels, and white blood cell counts at the time of genetic amniocentesis related with preterm delivery?
abstract: OBJECTIVE
  To compare women with spontaneous preterm delivery before 37 weeks and women who delivered at term with respect to amniotic fluid C-reactive protein (CRP), glucose levels, and white blood cell counts at the time of genetic amniocentesis.
  
  
  METHODS
  The study was conducted on 216 pregnant women who underwent genetic amniocentesis between the 15th and 18th weeks of gestation at Baskent University Obstetrics and Gynecology Department. All patients were followed until delivery for the occurrence of pregnancy complication. Indications for amniocentesis included abnormal triple test results showing increased risk for Down's syndrome, advanced maternal age and sonographic findings indicative for chromosomal abnormalities. The samples were carried immediately to the laboratory for cytogenetic and biochemical examination. Women with spontaneous preterm delivery before 37 weeks (n = 20) and those who delivered at term (n = 196) were compared with respect to some maternal and infant characteristics, amniotic fluid C-reactive protein, glucose levels, and amniotic fluid white blood cell counts.
  
  
  RESULTS
  During the study period 244 patients underwent amniocentesis. A chromosomal abnormality was present in 11 patients. 1 patient had a spontaneous pregnancy loss within 3 weeks after the procedure and 16 patients were delivered for fetal or maternal indications (preeclampsia, fetal growth restriction, placenta previa). The remaining 216 women were included in the study and investigated for the risk of preterm delivery. The prevalence of spontaneous preterm delivery before 37 weeks was 9.3% (20/216). There were no significant differences between the preterm delivery and the term delivery groups with respect to C-reactive protein levels and white blood cell counts. Mean amniotic glucose levels were significantly lower in the preterm delivery group (P<0.05). Amniotic fluid glucose levels of < or = 46 mg/dL had a sensitivity of 100% and NPV of 100%.
  
  
  CONCLUSIONS
  Amniotic fluid glucose levels at the time of genetic amniocentesis are lower in women with spontaneous preterm delivery before 37 weeks compared to those who delivered at term. Amniotic fluid glucose levels of < or = 46 mg/dL at the time of genetic amniocentesis may be more sensitive, cheaper and have higher negative predictive value than C-reactive protein levels and white blood cell counts for the prediction of patients in spontaneous preterm labor. The greatest benefit of amniotic fluid glucose testing might be when the physician judges the patient to be at low risk for preterm delivery.
authors.affiliation: Department of Obstetrics & Gynecology, Baskent University School of Medicine, Turkey. eatarim@hotmail.com
authors.forename: Ebru
authors.initials: E
authors.lastname: Tarim
authors.forename: Tayfun
authors.initials: T
authors.lastname: Bağiş
authors.forename: Esra Bulgan
authors.initials: EB
authors.lastname: Kiliçdağ
authors.forename: Nurzen
authors.initials: N
authors.lastname: Sezgin
authors.forename: Filiz
authors.initials: F
authors.lastname: Yanik
mesh_terms: D000649:Amniocentesis; D000653:Amniotic Fluid / Q000166:cytology* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002452:Cell Count; D002821:Chorioamnionitis / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D007962:Leukocytes; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology* / Q000378:metabolism; D011446:Prospective Studies
chemical_list: D002097:C-Reactive Protein; D005947:Glucose