Department of Maternal-Fetal Medicine, Institute Clinic of Gynecology, Obstetrics and Neonatology, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2009 Oct;34(4):441-7. doi: 10.1002/uog.6437.
To evaluate cervical length and gestational age as predictors of intra-amniotic inflammation in patients admitted because of preterm labor and intact membranes.
Ninety-three pregnant women with preterm labor and intact membranes were included in our study. Cervical length was measured on admission by transvaginal sonography and transabdominal amniocentesis was performed within the first 48 h following admission. Positive amniotic fluid cultures defined intra-amniotic infection. Levels of intra-amniotic interleukin-6 (IL-6) were measured, and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off point of IL-6 for predicting intra-amniotic infection. This value was then used as a basis for determining a cut-off of IL-6 for defining intra-amniotic inflammation. Considering inflammatory status, perinatal outcomes were evaluated and compared. Logistic regression was used to investigate associations of different explanatory variables with inflammatory status. A non-invasive approach for detection of intra-amniotic inflammation in women admitted because of preterm labor with intact membranes was evaluated.
Intra-amniotic infection and inflammation rates were 14% and 28%, respectively. ROC curve analysis showed that the best cut-off value for IL-6 was 13.4 ng/mL for predicting intra-amniotic infection, which was comparable to the cut-off of 11.3 ng/mL reported previously by other authors (which we used to define inflammation). Regardless of the intra-amniotic microbial status, perinatal outcomes in women who developed intra-amniotic inflammation were worse than in those who did not. Cervical length < 15 mm and gestational age at admission < 28 weeks were independently associated with intra-amniotic inflammation. A strategy considering these two non-invasive parameters (either women admitted < 28 weeks or women admitted between >or= 28 and < 32 weeks with a cervical length < 15 mm) could detect 84.0% of women with intra-amniotic inflammation with a positive predictive value of 48.8%, providing improved diagnostic indices compared to either variable considered alone.
Cervical length and gestational age at admission can be used as a non-invasive method to assess the risk of intra-amniotic inflammation in preterm labor and intact membranes.
评估宫颈长度和孕周作为胎膜完整的早产患者发生羊膜腔内炎症的预测指标。
本研究纳入了 93 例因早产和胎膜完整而入院的孕妇。入院时通过经阴道超声测量宫颈长度，并在入院后 48 小时内进行经腹羊膜腔穿刺术。阳性羊水培养定义为羊膜腔内感染。测量羊水中的白细胞介素-6（IL-6）水平，并构建受试者工作特征（ROC）曲线，以确定 IL-6 预测羊膜腔内感染的最佳截断点。然后，将此值用作确定 IL-6 截断值以定义羊膜腔内炎症的基础。考虑炎症状态，评估和比较围产结局。使用逻辑回归分析不同解释变量与炎症状态的关系。评估并比较一种用于检测因早产和胎膜完整而入院的女性羊膜腔内炎症的非侵入性方法。
羊膜腔内感染和炎症发生率分别为 14%和 28%。ROC 曲线分析显示，IL-6 预测羊膜腔内感染的最佳截断值为 13.4ng/mL，与之前其他作者报道的 11.3ng/mL 截断值（我们用于定义炎症的截断值）相当。无论羊膜腔内微生物状态如何，发生羊膜腔内炎症的女性的围产结局均较未发生炎症者差。宫颈长度<15mm 和入院时孕周<28 周与羊膜腔内炎症独立相关。考虑这两个非侵入性参数的策略（入院时孕周<28 周或入院时孕周在>或=28 至<32 周且宫颈长度<15mm 的女性）可以检测到 84.0%的羊膜腔内炎症患者，其阳性预测值为 48.8%，与单独考虑任一变量相比，提供了改善的诊断指标。
宫颈长度和入院时的孕周可作为一种非侵入性方法，用于评估胎膜完整的早产患者发生羊膜腔内炎症的风险。
