Vaisbuch Edi, Romero Roberto, Erez Offer, Kusanovic Juan Pedro, Gotsch Francesca, Than Nandor G, Mazaki-Tovi Shali, Mittal Pooja, Edwin Sam, Hassan Sonia S
Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA.
Am J Obstet Gynecol. 2008 Oct;199(4):426.e1-7. doi: 10.1016/j.ajog.2008.06.075.
Discolored amniotic fluid (AF) has been associated with intraamniotic infection/inflammation (IAI) in patients with preterm labor (PTL). The presence of hemoglobin and its catabolic products has been implicated as a cause for AF discoloration. The aim of this study was to determine whether there is an association between total hemoglobin concentration in AF and gestational age, spontaneous labor (term and preterm), and the presence or absence of IAI.
This cross-sectional study included patients in the following groups: (1) mid trimester (n = 65 patients); (2) term not in labor (n = 22 patients); (3) term in labor (n = 47 patients); (4) spontaneous PTL who delivered at term (n = 92 patients); (5) PTL without IAI who delivered preterm (n = 76 patients); (6) PTL with IAI (n = 81 patients); (7) preterm prelabor rupture of the membranes (PPROM) with IAI (n = 48 patients); and (8) PPROM without IAI (n = 49 patients). Total hemoglobin concentrations in amniotic fluid were determined by an enzyme-linked immunoassay. Nonparametric statistics were used for analysis.
Hemoglobin was detected in all AF samples (n = 480). The median AF total hemoglobin concentration at term was significantly higher than in mid trimester (520.6 ng/mL [interquartile range (IQR), 271.2-1549.2] vs 58.5 ng/mL [IQR, 26.1-200.8]; P < .001]). Among patients with PTL, the median AF total hemoglobin concentration was significantly higher in patients with IAI than in patients without IAI (4671.7 ng/mL [IQR, 1294.2-8620.7] vs 2013.6 ng/mL [IQR, 629.2-5420.4]; P = .01) or women who delivered at term (1143.4 ng/mL [IQR, 451.8-4037.9]; P = .001). Similarly, among patients with PPROM, the median AF total hemoglobin concentration was significantly higher in patients with IAI than in patients without IAI (10753.7 ng/mL [IQR, 2053.9-56026.6] vs 2281 ng/mL [IQR, 938.2-9191.7]; P = .02). Women at term in labor had a higher median hemoglobin concentration than did women who were not in labor (1952.6 ng/mL [IQR, 709.6-6289.2] vs 520.6 ng/mL [IQR, 271.1-1549.2]; P = .003).
The AF concentration of immunoreactive total hemoglobin increases with advancing gestational age, and is elevated in pregnancies that are complicated with IAI. Spontaneous labor at term is associated with higher AF concentrations of total hemoglobin.
在早产（PTL）患者中，羊水（AF）变色与羊膜腔内感染/炎症（IAI）有关。血红蛋白及其分解代谢产物的存在被认为是羊水变色的一个原因。本研究的目的是确定羊水中总血红蛋白浓度与孕周、自然分娩（足月和早产）以及IAI的有无之间是否存在关联。
这项横断面研究纳入了以下几组患者：（1）孕中期（n = 65例患者）；（2）足月未临产（n = 22例患者）；（3）足月临产（n = 47例患者）；（4）足月分娩的自发性PTL（n = 92例患者）；（5）未发生IAI的早产PTL（n = 76例患者）；（6）发生IAI的PTL（n = 81例患者）；（7）伴有IAI的早产胎膜早破（PPROM）（n = 48例患者）；以及（8）未发生IAI的PPROM（n = 49例患者）。采用酶联免疫分析法测定羊水中的总血红蛋白浓度。使用非参数统计进行分析。
在所有羊水样本（n = 480）中均检测到血红蛋白。足月时羊水总血红蛋白浓度的中位数显著高于孕中期（520.6 ng/mL [四分位间距（IQR），271.2 - 1549.2] 对比58.5 ng/mL [IQR，26.1 - 200.8]；P <.001）。在PTL患者中，发生IAI的患者羊水总血红蛋白浓度中位数显著高于未发生IAI的患者（4671.7 ng/mL [IQR，1294.2 - 8620.7] 对比2013.6 ng/mL [IQR，629.2 - 5420.4]；P =.01）或足月分娩的女性（1143.4 ng/mL [IQR，451.8 - 4037.9]；P =.001）。同样，在PPROM患者中，发生IAI的患者羊水总血红蛋白浓度中位数显著高于未发生IAI的患者（10753.7 ng/mL [IQR，2053.9 - 56026.6] 对比2281 ng/mL [IQR，938.2 - 9191.7]；P =.02）。足月临产的女性血红蛋白浓度中位数高于未临产的女性（1952.6 ng/mL [IQR，709.6 - 6289.2] 对比520.6 ng/mL [IQR，271.1 - 1549.2]；P =.003）。
免疫反应性总血红蛋白的羊水浓度随孕周增加而升高，并且在合并IAI的妊娠中升高。足月自然分娩与羊水中总血红蛋白浓度较高有关。
