Obstet Gynecol Sci.  2013 Jul;56(4):227-233.

Which is more important for the intensity of intra-amniotic inflammation between total grade or involved anatomical region in preterm gestations with acute histologic chorioamnionitis?

• Park CW
• Yoon BH
• Kim SM
• Park JS
• Jun JK

Abstract

OBJECTIVE
There is no data on which is more important for the intensity of intra-amniotic inflammation (IAI) between total grade or involved anatomical region in acute histologic chorioamnionitis (acute-HCA) of preterm-gestations. The objective of current study is to examine this issue.
METHODS
The intensity of IAI was measured by amniotic fluid (AF) white blood cell (WBC) count and matrix metalloproteinase-8 (MMP-8) concentration in 225 singleton preterm-gestations (<36 weeks) who had acute-HCA including chorio-decidua involvement and delivered within 5 days of amniocentesis. Acute-HCA was defined in the presence of acute inflammatory changes in each anatomical region (i.e., chorio-decidua, amnion or chorionic plate). Patients were divided into 6 groups according to total grade (i.e., 1-6) and the presence or absence of chorio-decidua restriction (i.e., chorio-decidua restriction vs. extension beyond chorio-decidua) of acute-HCA.
RESULTS
There was no significant difference in a median AF WBC and MMP-8 between the two groups (group-1, cases with total grade 1 vs. group-2, cases with total grade 2) among cases with chorio-decidua restriction (each for P>0.05) and between the four groups (group-3, cases with total grade 2 vs. group-4, cases with total grade 3 vs. group-5, cases with total grade 4 vs. group-6, cases with total grade 5-6) among cases with extension beyond chorio-decidua (each for P>0.05). However, group-3 (cases with extension beyond chorio-decidua) had a significantly higher median AF WBC and MMP-8 than group-2 (cases with chorio-decidua restriction) among cases with total grade 2 (each for P<0.05).
CONCLUSION
Involved anatomical region is more important than total grade for the intensity of IAI in acute-HCA of preterm-gestations.

Keyword

Amniotic fluid; Chorioamnionitis; Grade; Inflammation; Intensity; Region

MeSH Terms

Amniocentesis
Amnion
Amniotic Fluid
Chorioamnionitis
Chorion
Female
Humans
Inflammation
Leukocytes
Matrix Metalloproteinase 8
Pregnancy
Matrix Metalloproteinase 8

Figure

• 

  Fig. 1 Amniotic fluid matrix metalloproteinase-8 (MMP-8) concentrations according to total grade and the presence or absence of chorio-decidua restriction among preterm gestations with acute histologic chorioamnionitis including the involvement of chorio-decidua (median [range], ng/mL; group-1: 10.1 [0.3-4,202.7] vs. group-2: 107.85 [0.3-909.4] vs. group-3: 393.1 [0.3-3,929.0] vs. group-4: 486.15 [0.4-3,392.0] vs. group-5: 408.6 [0.6-6,142.6] vs. group-6: 454.0 [0.5-5,019.5]) (each and all P-value is shown in graph). NS, not significant.

• 

  Fig. 2 Amniotic fluid white blood cell (WBC) counts according to total grade and the presence or absence of chorio-decidua restriction among preterm gestations with acute histologic chorioamnionitis including the involvement of chorio-decidua (median [range], cells/mm3; group-1: 3 [0-10000] vs. group-2: 64 [0-2,800] vs. group-3: 773 [0-13,248] vs. group-4: 435 [0-15,000] vs. group-5: 884 [1-19,764] vs. group-6: 380 [0-8,640]) (each and all P-value is shown in graph). NS, not significant.

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