title: Maternal inflammatory markers and term labor performance.
abstract: OBJECTIVE
  We sought to examine the relationship between maternal markers of inflammation and labor performance.
  
  
  METHODS
  A nested cohort study was performed utilizing an established cohort of term nulliparous patients. Maternal blood was collected at the onset of regular, painful contractions in patients undergoing labor induction or at admission in patients with spontaneous labor. Levels of cytokines including interleukin (IL)-1, IL-6, and tumor necrosis factor-α were determined using standard multiplex methodology. Maternal demographic data were collected prospectively. Detailed retrospective chart review was performed to extract data on cervical dilation, effacement, and station during labor. Subjects were excluded if they failed to achieve complete dilation. Mixed effects modeling was used to examine the association between serum cytokine quartiles and labor progress in the latent and active phases.
  
  
  RESULTS
  In all, 334 women were included in our analysis. The lowest quartile of IL-6 was associated with slower latent labor (P = .001). In contrast, the highest quartiles of IL-1 and tumor necrosis factor-α were associated with slower active labor (P = .03 and .0002, respectively).
  
  
  CONCLUSIONS
  Proinflammatory activation is important in labor initiation. However, once active labor is established, excess inflammation can be detrimental to efficient labor progress. These data may explain, in part, the known associations among clinical chorioamnionitis, cesarean delivery, and postpartum hemorrhage.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
authors.forename: Jill T
authors.initials: JT
authors.lastname: Cierny
authors.affiliation: Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: E Ramsey
authors.initials: ER
authors.lastname: Unal
authors.affiliation: Department of Anesthesia, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Flood
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Ka Young
authors.initials: KY
authors.lastname: Rhee
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
authors.forename: Allison
authors.initials: A
authors.lastname: Praktish
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Los Angeles, School of Medicine, Los Angeles, CA.
authors.forename: Tara Hudak
authors.initials: TH
authors.lastname: Olson
authors.affiliation: Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, PA.
authors.forename: Laura
authors.initials: L
authors.lastname: Goetzl
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: cytokines; failure to progress; inflammation; interleukins; labor