Amniotic Fluid Infection in Preterm Pregnancies with Intact Membranes.
Introduction. Intra-amniotic infection (IAI) is a major cause of preterm labor and adverse neonatal outcome. We evaluated amniotic fluid (AF) proteolytic cascade forming biomarkers in relation to microbial invasion of the amniotic cavity (MIAC) and IAI in preterm pregnancies with intact membranes.Material and Methods. Amniocentesis was made to 73 women with singleton pregnancies; 27 with suspected IAI; and 46 controls. AF biomarkers were divided into three cascades: Cascade 1: matrix metalloproteinase-8 (MMP-8), MMP-9, myeloperoxidase (MPO), and interleukin-6; Cascade 2: neutrophil elastase (HNE), elafin, and MMP-9; Cascade 3: MMP-2, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), MMP-8/TIMP-1 molar ratio, and C-reactive protein (CRP). MMP-8 was measured by an immunoenzymometric assay and the others were measured by ELISA. Standard biochemical methods, molecular microbiology, and culture techniques were used.Results. MMP-8, MMP-9, MPO, elafin, and TIMP-1 concentrations were higher in IAI suspected cases compared to controls and also in IAI suspected cases with MIAC compared to those without MIAC when adjusted by gestational age at amniocentesis. All biomarkers except elafin and MMP-2 had the sensitivity of 100% with thresholds based on ROC-curve. Odd ratios of biomarkers for MIAC were 1.2-38 and 95% confidential intervals 1.0-353.6.Conclusions. Neutrophil based AF biomarkers were associated with IAI and MIAC.
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Tarja
0000-0002-7203-4416
T
Myntti
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Leena
L
Rahkonen
Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Irmeli
I
Nupponen
Department of Bacteriology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland.
Anu
A
Pätäri-Sampo
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Minna
M
Tikkanen
Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Institute of Dentistry, University of Helsinki, Helsinki, Finland; Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
Timo
T
Sorsa
Medix Biochemica, Espoo, Finland.
Juuso
J
Juhila
Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Sture
S
Andersson
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Jorma
J
Paavonen
Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Vedran
V
Stefanovic
D000328:Adult; D000653:Amniotic Fluid / Q000201:enzymology / Q000378:metabolism* / Q000382:microbiology; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D053492:Elafin / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D019272:Leukocyte Elastase / Q000378:metabolism; D020782:Matrix Metalloproteinases / Q000378:metabolism; D009195:Peroxidase / Q000378:metabolism; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000378:metabolism*; D047928:Premature Birth / Q000175:diagnosis / Q000378:metabolism*; D059748:Proteolysis; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism
D015415:Biomarkers; D053492:Elafin; D015850:Interleukin-6; D019715:Tissue Inhibitor of Metalloproteinase-1; D009195:Peroxidase; D019272:Leukocyte Elastase; D020782:Matrix Metalloproteinases