title: Maternal Serum C-Reactive Protein in Women with Preterm Prelabor Rupture of Membranes.
abstract: OBJECTIVE
  This study evaluated maternal C-reactive protein (CRP) as a predictor of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with preterm prelabor rupture of the membranes (PPROM) before and after 32 weeks of gestation.
  
  
  METHODS
  This study was a prospective observational cohort study of 386 women. Maternal serum CRP concentrations were evaluated, and amniotic fluid samples were obtained via transabdominal amniocentesis at the time of admission. Placentas underwent histopathological examination after delivery. MIAC was defined based on a positive PCR for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive 16S rRNA gene amplification. HCA was defined based on the Salafia classification.
  
  
  RESULTS
  Maternal CRP was significantly higher in women with MIAC and HCA (median 9.0 mg/l) than in women with HCA alone (median 6.9 mg/l), MIAC alone (median 7.4 mg/l) and without MIAC or HCA (median 4.5 mg/l) (p<0.0001). CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation. Only the 95th percentile of CRP and PPROM before 32 weeks exhibited a false-positive rate of 1%, a positive predictive value of 90% and a positive likelihood ratio of 13.2 to predict MIAC and HCA. However, the low sensitivity of 15% limits the clinical utility of this detection.
  
  
  CONCLUSIONS
  CRP is a poor predictor of the occurrence of MIAC and HCA, even at early gestational ages.
authors.affiliation: Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Stepan
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska academy, Sahlgrenska University Hospital, Gothenburg, Sweden.|BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cobo
authors.affiliation: Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Musilova
authors.affiliation: Fingerland´s Department of Pathology, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Helena
authors.initials: H
authors.lastname: Hornychova
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska academy, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo University, Oslo, Norway.
authors.forename: Bo
authors.initials: B
authors.lastname: Jacobsson
authors.affiliation: Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic.|Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Kacerovsky
mesh_terms: D000328:Adult; D017677:Age Distribution; D000653:Amniotic Fluid / Q000382:microbiology; D058491:Bacterial Load; D002097:C-Reactive Protein / Q000378:metabolism*; D002821:Chorioamnionitis / Q000097:blood; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000097:blood*; D008954:Models, Biological; D007752:Obstetric Labor, Premature / Q000097:blood*; D011247:Pregnancy; D014509:Ureaplasma / Q000502:physiology
chemical_list: D002097:C-Reactive Protein