J Korean Med Sci.  2013 Aug;28(8):1226-1232. 10.3346/jkms.2013.28.8.1226.

Intra-Amniotic Infection/Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor

• Lee SY
• Park KH
• Jeong EH
• Oh KJ
• Ryu A
• Kim A

• KMID: 1793030
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1226

Abstract

The aim of this study was to determine whether intra-amniotic infection/inflammation (IAI) was associated with subsequent ruptured membranes in women with preterm labor and intact membranes who had a clinically indicated amniocentesis. This retrospective cohort study included 237 consecutive women with preterm labor (20-34.6 weeks) who underwent amniocentesis. The clinical and laboratory parameters evaluated included demographic variables, gestational age, C-reactive protein (CRP) and amniotic fluid (AF) white blood cell, interleukin-6 (IL-6) and culture results. IAI was defined as a positive AF culture and/or an elevated AF IL-6 level (>2.6 ng/mL). The primary outcome was ruptured membranes in the absence of active labor occurring within 48 hours of amniocentesis. Preterm premature rupture of membranes subsequently developed in 10 (4.2%) women within 48 hr of amniocentesis. Multivariate analysis demonstrated that only IAI was independently associated with the ruptured membranes occurring within 48 hr of amniocentesis. In the predictive model based on variables assessed before amniocentesis, only CRP level was retained. IAI is an independent risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. Prior to amniocentesis, measurement of serum CRP level can provide a risk assessment for the subsequent development of ruptured membranes after the procedure.

Keyword

Amniocentesis; C-Reactive Protein; Intra-Amniotic Infection/Inflammation; Obstetric Labor, Premature; Ruptured Membranes

MeSH Terms

Adult
Amniocentesis/*adverse effects
Amnion/physiopathology
Amniotic Fluid/cytology/metabolism/microbiology
Bacterial Infections/*etiology/microbiology
C-Reactive Protein/analysis
Cohort Studies
Demography
Female
Gestational Age
Humans
Inflammation/*etiology
Interleukin-6/metabolism
Leukocytes/cytology
Multivariate Analysis
Mycoplasma/isolation & purification
Obstetric Labor, Premature/*etiology
Pregnancy
ROC Curve
Retrospective Studies
Risk Factors
Ureaplasma urealyticum/isolation & purification
C-Reactive Protein
Interleukin-6