The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency.
OBJECTIVE
The purpose of this study was to determine the frequency and clinical significance of intraamniotic inflammation in patients with acute cervical insufficiency.


METHODS
Amniocentesis was performed in 52 patients with acute cervical insufficiency (cervical dilation, > or =1.5 cm) and intact membranes and without regular uterine contractions (gestational age, 17-29 weeks). Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8. Intraamniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 concentration (>23 ng/mL). Nonparametric statistics and survival techniques were used for analysis.


RESULTS
The prevalence of intraamniotic inflammation was 81% (42/52); the prevalence of a positive AF culture was 8% (4/52). Intraamniotic inflammation was present in all cases with a positive AF culture. Preterm delivery within 7 days occurred in 50% of cases (19/38), and delivery before 34 weeks of gestation occurred in 84% of cases (32/38) with intraamniotic inflammation but without AF infection. Fifty-five percent of newborn infants (21/38) who were born to mothers with intraamniotic inflammation but without AF infection died immediately after birth (<1 day). The amniocentesis-to-delivery interval was shorter in patients with intraamniotic inflammation than in those without inflammation (P < .05). There were no differences in the interval-to-delivery or the rate of adverse outcome between patients with intraamniotic inflammation and a negative culture and patients with proven AF infection.


CONCLUSIONS
Intraamniotic inflammation, regardless of AF culture result, is present in approximately 80% of patients with acute cervical insufficiency and is a risk factor for impending preterm delivery and adverse outcomes.
Lee
Si Eun
SE
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Romero
Roberto
R
Park
Chan-Wook
CW
Jun
Jong Kwan
JK
Yoon
Bo Hyun
BH
D000328:Adult; D000653:Amniotic Fluid / Q000276:immunology / Q000382:microbiology*; D002821:Chorioamnionitis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000276:immunology*; D005865:Gestational Age; D006801:Humans; D020784:Matrix Metalloproteinase 8 / Q000032:analysis*; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D002581:Uterine Cervical Incompetence / Q000382:microbiology*
D020784:Matrix Metalloproteinase 8