Predictive value of vaginal IL-6 and TNFα bedside tests repeated until delivery for the prediction of maternal-fetal infection in cases of premature rupture of membranes.
OBJECTIVE
Examine the predictive value for maternal-fetal infection of routine bedside tests detecting the proinflammatory cytokines, TNFα and IL-6, in the vaginal secretions of women with premature rupture of the membranes (PROM).


METHODS
This prospective two-center cohort study included all women hospitalized for PROM over a 2-year period. A bedside test assessed IL-6 and TNFα in vaginal secretions. Both centers routinely tested CRP and leukocytes, assaying both in maternal serum, and analyzed vaginal bacterial flora; all samples were repeated twice weekly until delivery.


RESULTS
The study included 689 women. In cases of preterm PROM (PPROM) before 37 weeks (n=184), a vaginal sample positive for one or more bacteria was the only marker associated with early neonatal infection (OR 5.6, 95%CI; 2.0-15.7). Its sensitivity was 82% (95%CI; 62-94) and its specificity 56% (95%CI; 47-65). All positive markers of infection were associated with the occurrence of chorioamnionitis. In cases of PROM from 37 weeks onward (n=505), only CRP >5mg/dL was associated with early neonatal infection (OR=8.3, 95%CI; 1.1-65.4) or clinical chorioamnionitis (OR=6.8, 95%CI; 1.5-30.0). The sensitivity of CRP >5mg/dL was 91% (95%CI; 59-100) and its specificity 45% (95%CI; 40-51) for predicting early neonatal infection, and 89% (95%CI; 65-99) and 46% (95%CI; 41-51), respectively, for predicting clinical chorioamnionitis.


CONCLUSIONS
The association of vaginal cytokines with maternal-fetal infection is weak and thus prevents their use as a good predictor of maternal-fetal infection. CRP and vaginal samples may be useful for identifying a group of women at low risk of infection.
Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France. Electronic address: gkayem@gmail.com.
Gilles
G
Kayem
Department of Clinical Immunology Cochin Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Frederic
F
Batteux
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France.
Noémie
N
Girard
Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France.
Thomas
T
Schmitz
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France.
Marion
M
Willaime
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France.
Francoise
F
Maillard
Department of Neonatology, Cochin, Broca, Hôtel Dieu Hospital, AP-HP, Paris, France.
Pierre Henri
PH
Jarreau
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, AP-HP, Paris, France.
Francois
F
Goffinet
D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis*; D015415:Biomarkers; D001826:Body Fluids / Q000737:chemistry*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000378:metabolism / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000032:analysis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D014621:Vagina / Q000378:metabolism*
D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
IL-6; Maternal-fetal infection; Rupture of membranes; TNFα