title: Non-invasive prediction of intra-amniotic infection and/or inflammation in patients with cervical insufficiency or an asymptomatic short cervix (≤15 mm).
abstract: OBJECTIVE
  To identify non-invasive parameters to predict intra-amniotic infection and/or inflammation (IAI) in patients with cervical insufficiency or an asymptomatic short cervix (≤15 mm).
  
  
  METHODS
  This retrospective cohort study included 72 asymptomatic women with cervical insufficiency (n = 54) or an asymptomatic short cervix (n = 18) at 17-28 weeks. Maternal blood was collected for the determination of the C-reactive protein (CRP) level and white blood cell (WBC) count, and sonography was performed to measure the cervical length shortly after amniocentesis. Amniotic fluid (AF) was cultured and interleukin-6 (IL-6) level and WBC count were determined.
  
  
  RESULTS
  The prevalence of intra-amniotic inflammation and a positive AF culture was 22.2 % (16/72) and 8.3 % (6/72), respectively. The best cut-off value for AF IL-6 in predicting the presence of intra-amniotic infection was ≥7.6 ng/mL and was used to diagnose the presence of intra-amniotic inflammation. Women with intra-amniotic inflammation, regardless of culture results, were at increased risk for preterm delivery and adverse outcomes compared to women without intra-amniotic inflammation. In multivariable regression, CRP was the only non-invasive variable statistically significantly associated with IAI. Moreover, the area under the curves for the CRP and AF WBC were not significantly different.
  
  
  CONCLUSIONS
  In women with cervical insufficiency or a short cervix, the risk for IAI can be predicted fairly and non-invasively by measurements of serum CRP. Overall, this non-invasive parameter appears to have similar accuracy to the AF WBC counts for predicting IAI.
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Jung
authors.forename: Kyo Hoon
authors.initials: KH
authors.lastname: Park
authors.forename: Sung Youn
authors.initials: SY
authors.lastname: Lee
authors.forename: Aeli
authors.initials: A
authors.lastname: Ryu
authors.forename: Kyung Joon
authors.initials: KJ
authors.lastname: Oh
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000379:methods*; D000653:Amniotic Fluid / Q000737:chemistry / Q000378:metabolism / Q000382:microbiology*; D002097:C-Reactive Protein / Q000032:analysis; D002584:Cervix Uteri / Q000378:metabolism / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000378:metabolism / Q000382:microbiology; D015850:Interleukin-6; D007958:Leukocyte Count; D007752:Obstetric Labor, Premature / Q000175:diagnosis / Q000378:metabolism / Q000382:microbiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000378:metabolism / Q000382:microbiology*; D047928:Premature Birth / Q000378:metabolism; D011446:Prospective Studies; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence; D014621:Vagina / Q000378:metabolism / Q000382:microbiology*
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein