title: Amniotic fluid inflammation with negative culture and outcome after cervical cerclage.
abstract: OBJECTIVE
  To determine whether amniotic fluid (AF) inflammation, in the absence of infection, is associated with adverse pregnancy outcomes in nonelective cervical cerclage patients.
  
  
  METHODS
  A retrospective case-control study was carried out. The patient population included 82 singleton pregnancies with negative AF cultures. The variables used to define AF inflammation were white blood cell count (WBC) >50 cell/mm(3), glucose <14 mg/dl or interleukin-6 (IL-6) >11.3 ng/ml. The study group consisted of cases with intra-amniotic inflammation. Sub-analysis was performed for the groups in which IL-6 concentrations were measured. Adverse outcomes were evaluated with variables such as gestational age at delivery, interval from cerclage to delivery, chorioamnionitis and cumulative neonatal morbidity.
  
  
  RESULTS
  Elevated AF WBC was correlated with severe and extreme preterm delivery (p < 0.05). Decreased AF glucose was associated with histological chorioamnionitis and a decreased cerclage to delivery interval (p < 0.05). Elevated AF IL-6 correlated significantly with decreased gestational age at delivery (p < 0.012) and decreased cerclage to delivery interval (p < 0.001). Elevated IL-6 concentrations were associated with severe, extreme preterm delivery (p < 0.001) and neonatal death (p < 0.001).
  
  
  CONCLUSIONS
  Elevated AF IL-6, elevated WBC and low AF glucose, in the absence of a positive AF culture, are significantly associated with adverse pregnancy outcomes in patients undergoing nonelective cerclage.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. eaguin@hotmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Aguin
authors.forename: Tina
authors.initials: T
authors.lastname: Aguin
authors.forename: Marcos
authors.initials: M
authors.lastname: Cordoba
authors.forename: Victor
authors.initials: V
authors.lastname: Aguin
authors.forename: Robyn
authors.initials: R
authors.lastname: Roberts
authors.forename: Samet
authors.initials: S
authors.lastname: Albayrak
authors.forename: Michael
authors.initials: M
authors.lastname: Kruger
authors.forename: Ray
authors.initials: R
authors.lastname: Bahado-Singh
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000276:immunology / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D023802:Cerclage, Cervical; D002821:Chorioamnionitis / Q000209:etiology* / Q000473:pathology; D005260:Female; D005865:Gestational Age; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality; D007249:Inflammation / Q000175:diagnosis / Q000276:immunology / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism; D007958:Leukocyte Count; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery*
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D005947:Glucose