Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands.
Obstet Gynecol Surv. 2012 Mar;67(3):187-200. doi: 10.1097/OGX.0b013e31824bb5f1.
Intrauterine infection is a serious complication during labor at term and is associated with adverse neonatal outcome. Early and accurate diagnosis is of great concern for both obstetrician and pediatrician with the use of current diagnostics. Clinical symptoms are often regarded as the main sign of intrauterine infection but this approach is highly unreliable and leads to both under- and overtreatment. Currently, no distinct fetal heart rate (FHR) patterns have been found that reliably identify neonates with intrauterine infection. Using a systematic literature search, this article reviews possible markers for the early detection of intrauterine or neonatal infection in maternal serum, amniotic fluid, and umbilical cord blood during labor at term. Maternal serum markers, with the possible exception of interleukin (IL)-8, are unreliable for the detection of intrauterine infection. In contrast, amniotic fluid levels of especially IL-6 and IL-8 are significantly associated with intrauterine infection. Umbilical cord blood IL-6 has been extensively investigated and is usually elevated in case of intrauterine or neonatal infection but shows only modest positive and negative predictive values (NPVs) for clinical use. Umbilical cord IL-8 concentration could be a valuable addition in the diagnostic process, as it has shown to have an NPV of 84% to 92% in the detection of neonatal infection and histological chorioamnionitis. Future research is essential and should focus on the combination of different markers and on the development of a prediction model, to improve the positive and NPVs of our arsenal to detect intrauterine and neonatal infections. Amniotic fluid and umbilical cord values of IL-6 and IL-8 levels are likely candidates for such a prediction model.
Obstetricians & Gynecologists and Family Physicians
After the completing the CME activity, physicians should be better able to evaluate the use of clinical chorioamnionitis with regard to histological evidence and as a diagnostic tool in early diagnosis of intra-amniotic infection. Asses the use of amniotic fluid IL-6 and IL-8 as diagnostic tools to detect early intra-amniotic infection and assess umbilical cord blood IL-8 in case of intrauterine- or neonatal infection using positive (PPV) and negative predictive values (NPV).
探讨母体血清、羊水和脐带血中可能的标志物，用于在足月分娩时早期检测宫内或新生儿感染。目标受众：妇产科医生和家庭医生。学习目标：完成 CME 活动后，医生应能够更好地评估临床绒毛膜羊膜炎与组织学证据的关系，以及其作为早期诊断宫内感染的诊断工具的作用。评估羊水白细胞介素-6 和白细胞介素-8 作为诊断工具的作用，以检测早期宫内感染，并评估脐带血白细胞介素-8 在宫内或新生儿感染时的阳性预测值 (PPV) 和阴性预测值 (NPV)。
