title: The frequency and clinical significance of intra-amniotic inflammation in women with preterm uterine contractility but without cervical change: do the diagnostic criteria for preterm labor need to be changed?
abstract: OBJECTIVE
  The objective of this study was to determine the frequency and clinical significance of intra-amniotic inflammation in patients with preterm increased uterine contractility with intact membranes but without cervical change.
  
  
  METHODS
  Amniocentesis was performed in 132 patients with regular uterine contractions and intact membranes without cervical change. Amniotic fluid was cultured for bacteria and mycoplasmas and assayed for matrix metalloproteinase-8 (MMP-8). Intra-amniotic inflammation was defined as an elevated amniotic fluid MMP-8 concentration (>23 ng/mL).
  
  
  RESULTS
  (1) Intra-amniotic inflammation was present in 12.1% (16/132); (2) Culture-proven intra-amniotic infection was diagnosed in 3% (4/132) of patients without demonstrable cervical change on admission or during the period of observation; and (3) Patients with intra-amniotic inflammation had significantly higher rates of preterm delivery and adverse outcomes, and shorter amniocentesis-to-delivery intervals than those without intra-amniotic inflammation (P < 0.05 for each). Adverse outcomes included chorioamnionitis, funisitis, and neonatal death.
  
  
  CONCLUSIONS
  Intra-amniotic inflammation was present in 12% of patients with regular uterine contractions without cervical change, while culture-proven intra-amniotic infection was present in 3%. The presence of intra-amniotic inflammation was a significant risk factor for adverse neonatal outcomes. These observations question whether cervical changes should be required for the diagnosis of preterm labor, because patients without modifications in cervical status on admission or during a period of observation are at risk for adverse pregnancy outcomes.
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Sun Min
authors: SM
authors: Kim
authors: Roberto
authors: R
authors: Romero
authors: Joonho
authors: J
authors: Lee
authors: Seung
authors: S
authors: Mi Lee
authors: Chan-Wook
authors: CW
authors: Park
authors: Joong
authors: J
authors: Shin Park
authors: Bo Hyun
authors: BH
authors: Yoon
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000276:immunology; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002584:Cervix Uteri / Q000502:physiology; D002821:Chorioamnionitis / Q000175:diagnosis / Q000453:epidemiology*; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D011247:Pregnancy; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D014590:Uterine Contraction / Q000276:immunology / Q000502:physiology*; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult