Vaginal Fluid Inflammatory Biomarkers and the Risk of Adverse Neonatal Outcomes in Women with PPROM.
Objective The purpose of this study was to evaluate the predictive value of vaginal fluid biomarkers for chorioamnionitis and adverse perinatal outcomes in women with preterm premature rupture of membranes (PPROM). Methods We recruited women with PPROM, without clinical chorioamnionitis, between 22 and 36 weeks' gestation. Vaginal fluid was collected on admission for the measurement of metalloproteinase-8 (MMP-8), interleukin-6 (IL-6), lactate, and glucose concentration. Placental pathology and neonatal charts were reviewed. Primary outcomes were histological chorioamnionitis and adverse neonatal neurological outcomes (intraventricular hemorrhage grade 2 or 3, periventricular leukomalacia, or hypoxic/ischemic encephalopathy). Linear regression analyses were used to adjust for gestational age at PPROM. Results Twenty-seven women were recruited at a mean gestational age of 31.6 ± 3.1 weeks, including 25 (93%) with successful collection of vaginal fluid sample. Histological chorioamnionitis and adverse neonatal neurological outcomes were observed in nine (33%) and four (15%) cases, respectively. In univariate analysis, MMP-8, IL-6, glucose, and lactate concentrations in vaginal fluid were associated with the risk of chorioamnionitis but not anymore after adjustment for gestational age at PPROM. MMP-8 concentration was the only biomarker associated with adverse neurological outcome, and it remained significant after adjustment for gestational age at PPROM (p = 0.02). Conclusion Vaginal fluid inflammatory biomarkers at admission for PPROM could predict adverse perinatal outcomes.
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada.
Nydia
N
Dorfeuille
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada.
Valérie
V
Morin
Centre de recherche du CHU de Québec, Université Laval, Québec City, Canada.
Amélie
A
Tétu
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada.
Suzanne
S
Demers
Centre de recherche du CHU de Québec, Université Laval, Québec City, Canada.
Geneviève
G
Laforest
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada.
Katy
K
Gouin
Department of Pediatrics, Faculty of Medicine, Université Laval, Québec City, Canada.
Bruno
B
Piedboeuf
Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada.
Emmanuel
E
Bujold
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001826:Body Fluids / Q000737:chemistry; D002170:Canada; D002821:Chorioamnionitis / Q000175:diagnosis*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000473:pathology*; D005865:Gestational Age; D005947:Glucose / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000150:complications*; D015850:Interleukin-6 / Q000032:analysis; D019344:Lactic Acid / Q000032:analysis; D016014:Linear Models; D016015:Logistic Models; D020784:Matrix Metalloproteinase 8 / Q000032:analysis*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000175:diagnosis*; D011446:Prospective Studies; D014621:Vagina / Q000737:chemistry*; D055815:Young Adult
D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D019344:Lactic Acid; C488762:MMP8 protein, human; D020784:Matrix Metalloproteinase 8; D005947:Glucose