Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnamsi, Korea.
Ultrasound Obstet Gynecol. 2011 Jan;37(1):82-7. doi: 10.1002/uog.8869.
To develop a model based on non-invasive variables to predict the probability of intra-amniotic inflammation in women with preterm labor and intact membranes.
Transvaginal ultrasonography and digital examination for the assessment of cervical length and cervical dilatation were performed, and maternal blood was collected for the determination of C-reactive protein and white blood cell (WBC) count immediately after amniocentesis in 153 consecutive women with preterm labor. Amniotic fluid obtained by amniocentesis was cultured for aerobic and anaerobic bacteria and mycoplasmas, and the WBC was determined. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 concentration (> 2.6 ng/mL). Receiver-operating characteristics (ROC) curves and logistic regression analysis were used for statistical analysis.
The prevalence of a positive amniotic fluid culture was 7.2% (11/153) and the prevalence of intra-amniotic inflammation was 19.6% (30/153). The final logistic regression model was based on non-invasive clinical variables, including gestational age at assessment, cervical length and maternal blood WBC count, which were the best predictors of intra-amniotic inflammation. The model was shown to have an adequate goodness of fit (P = 0.754), and the area under the ROC curve was 0.724, indicating reasonably good discrimination.
In women with preterm labor and intact membranes, the risk for intra-amniotic inflammation can be predicted non-invasively with a risk score based on gestational age, cervical length and maternal blood WBC count.
建立一种基于非侵入性变量的模型，以预测胎膜完整的早产孕妇发生宫内炎症的概率。
对 153 例连续的早产孕妇进行经阴道超声检查和宫颈长度及宫颈扩张程度的数字检查，并在羊膜穿刺术后立即采集母体外周血检测 C 反应蛋白和白细胞（WBC）计数。通过羊膜穿刺术获得的羊水进行需氧菌和厌氧菌及支原体培养，并检测 WBC。将羊水中白细胞介素-6 浓度升高（>2.6ng/ml）定义为宫内炎症。采用受试者工作特征（ROC）曲线和逻辑回归分析进行统计学分析。
羊水培养阳性率为 7.2%（11/153），宫内炎症发生率为 19.6%（30/153）。最终的逻辑回归模型基于非侵入性临床变量，包括评估时的孕周、宫颈长度和母体外周血 WBC 计数，这些变量是宫内炎症的最佳预测指标。该模型拟合优度良好（P=0.754），ROC 曲线下面积为 0.724，表明具有较好的区分度。
对于胎膜完整的早产孕妇，基于孕周、宫颈长度和母体外周血 WBC 计数的风险评分，可以无创预测宫内炎症的风险。
