宫内炎症与足月自发性阴道分娩的关系：一项横断面研究。

The association between intrauterine inflammation and spontaneous vaginal delivery at term: a cross-sectional study.

机构信息

Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht University Medical Center, Utrecht, The Netherlands.

出版信息

PLoS One. 2009 Aug 10;4(8):e6572. doi: 10.1371/journal.pone.0006572.

BACKGROUND

Different factors contribute to the onset of labor at term. In animal models onset of labor is characterized by an inflammatory response. The role of intrauterine inflammation, although implicated in preterm birth, is not yet established in human term labor. We hypothesized that intrauterine inflammation at term is associated with spontaneous onset of labor.

METHODS/RESULTS: In two large urban hospitals in the Netherlands, a cross-sectional study of spontaneous onset term vaginal deliveries and elective caesarean sections (CS), without signs of labor, was carried out. Placentas and amniotic fluid samples were collected during labor and/or at delivery. Histological signs of placenta inflammation were determined. Amniotic fluid proinflammatory cytokine concentrations were measured using ELISA. A total of 375 women were included. In term vaginal deliveries, more signs of intrauterine inflammation were found than in elective CS: the prevalence of chorioamnionitis was higher (18 vs 4%, p = 0.02) and amniotic fluid concentration of IL-6 was higher (3.1 vs 0.37 ng/mL, p<0.001). Similar results were obtained for IL-8 (10.93 vs 0.96 ng/mL, p<0.001) and percentage of detectable TNF-alpha (50 vs 4%, p<0.001).

CONCLUSIONS

This large cross-sectional study shows that spontaneous term delivery is characterized by histopathological signs of placenta inflammation and increased amniotic fluid proinflammatory cytokines.

背景

不同的因素导致足月分娩的开始。在动物模型中，分娩的开始是以炎症反应为特征的。尽管宫内炎症与早产有关，但在足月分娩中其作用尚未确定。我们假设足月分娩时的宫内炎症与自发性分娩开始有关。

方法/结果：在荷兰的两家大型城市医院，对自发性足月阴道分娩和无分娩迹象的选择性剖宫产术（CS）进行了横断面研究。在分娩期间和/或分娩时收集胎盘和羊水样本。通过组织学确定胎盘炎症的迹象。使用 ELISA 测量羊水前炎症细胞因子的浓度。共有 375 名妇女入选。在足月阴道分娩中，发现的宫内炎症迹象多于选择性 CS：绒毛膜羊膜炎的患病率更高（18%比 4%，p=0.02），羊水 IL-6 浓度更高（3.1 比 0.37ng/ml，p<0.001）。IL-8（10.93 比 0.96ng/ml，p<0.001）和可检测 TNF-α的百分比（50 比 4%，p<0.001）也得到了类似的结果。