title: An elevated amniotic fluid prostaglandin F2α concentration is associated with intra-amniotic inflammation/infection, and clinical and histologic chorioamnionitis, as well as impending preterm delivery in patients with preterm labor and intact membranes.
abstract: OBJECTIVE
  To determine whether an elevated amniotic fluid concentration of prostaglandin F2α (PGF2α) is associated with intra-amniotic inflammation/infection and adverse pregnancy outcomes in patients with preterm labor and intact membranes.
  
  
  METHODS
  The retrospective cohort study included 132 patients who had singleton pregnancies with preterm labor (< 35 weeks of gestation) and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as for genital mycoplasmas. Intra-amniotic inflammation was defined by an elevated amniotic fluid matrix metalloproteinase-8 (MMP-8) concentration (>23 ng/mL). PGF2α was measured with a sensitive and specific immunoassay. The amniotic fluid PGF2α concentration was considered elevated when it was above the 95th percentile among pregnant women at 15-36 weeks of gestation who were not in labor (≥170 pg/mL).
  
  
  RESULTS
  (1) The prevalence of an elevated amniotic fluid PGF2α concentration was 40.2% (53/132) in patients with preterm labor and intact membranes; (2) patients with an elevated amniotic fluid PGF2α concentration had a significantly higher rate of positive amniotic fluid culture [19% (10/53) versus 5% (4/79); p = 0.019], intra-amniotic inflammation/infection [49% (26/53) versus 20% (16/79); p = 0.001], spontaneous preterm delivery, clinical and histologic chorioamnionitis, and funisitis, as well as a higher median amniotic fluid MMP-8 concentration and amniotic fluid white blood cell count and a shorter amniocentesis-to-delivery interval than those without an elevated concentration of amniotic fluid PGF2α (p < 0.05 for each); and (3) an elevated amniotic fluid PGF2α concentration was associated with a shorter amniocentesis-to-delivery interval after adjustment for the presence of intra-amniotic inflammation/infection [hazard ratio 2.1, 95% confidence interval (CI) 1.4-3.1; p = 0.001].
  
  
  CONCLUSIONS
  The concentration of PGF2α was elevated in the amniotic fluid of 40.2% of patients with preterm labor and intact membranes and is an independent risk factor for intra-amniotic inflammation/infection, impending preterm delivery, chorioamnionitis, and funisitis.
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .
authors.forename: Jee Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD , Detroit , MI , USA .|c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .|d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .|e Center for Molecular Medicine and Genetics, Wayne State University , Detroit , MI , USA , and.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .
authors.forename: JoonHo
authors.initials: J
authors.lastname: Lee
authors.affiliation: b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD , Detroit , MI , USA .|f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Piya
authors.initials: P
authors.lastname: Chaemsaithong
authors.affiliation: b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD , Detroit , MI , USA .|f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Noppadol
authors.initials: N
authors.lastname: Chaiyasit
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Yoon
mesh_terms: D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry* / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000382:microbiology; D015331:Cohort Studies; D015237:Dinoprost / Q000032:analysis*; D005321:Extraembryonic Membranes; D005260:Female; D005865:Gestational Age; D006801:Humans; D009174:Mycoplasma / Q000302:isolation & purification; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000209:etiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015237:Dinoprost
keywords: Acute inflammatory lesions of the placenta; MMP-8; amniocentesis; amniotic fluid infection; funisitis; mycoplasma; prematurity; prostanoids