Kacerovsky Marian, Matulova Jana, Andrys Ctirad, Mls Jan, Hornychova Helena, Kukla Rudolf, Bostik Pavel, Burckova Hana, Spacek Richard, Jacobsson Bo, Musilova Ivana
Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9145-9156. doi: 10.1080/14767058.2021.2017875. Epub 2021 Dec 17.
The absence of microbial invasion of the amniotic cavity and intra-amniotic inflammation at the time of hospital admission is the most common condition associated with preterm prelabor rupture of membranes (PPROM). Although the intensity of intra-amniotic inflammatory response does not exceed the threshold for the diagnosis of intra-amniotic inflammation in this subgroup of PPROM, whether there could be differences in outcomes concerning the intensity of intra-amniotic inflammatory response remains unclear. Therefore, the main aims of this study on PPROM without microbial invasion of the amniotic cavity and intra-amniotic inflammation were (i) to characterize the association between the intensity of intra-amniotic inflammatory response, measured according to amniotic fluid interleukin (IL)-6 concentrations, and the presence of acute histological chorioamnionitis and acute inflammation in the amnion; (ii) to characterize the association between the intensity of intra-amniotic inflammatory response and fetal inflammatory response, and (iii) to describe the short-term morbidity of infants based on the intensity of intra-amniotic inflammatory response.
This retrospective study included 131 women with singleton pregnancies with PPROM without microbial invasion of the amniotic cavity and intra-amniotic inflammation between gestational ages of 24 + 0 and 36 + 6 weeks and who had delivered within 72 h of membrane rupture. Microbial invasion of the amniotic cavity was assessed based on a combination of cultivation and non-cultivation methods. Intra-amniotic inflammation was characterized based on the amniotic fluid IL-6 concentration. In addition, a histopathological assessment of the placenta was performed. Fetal inflammatory response syndrome was characterized according to IL-6 concentration in the umbilical cord blood of >11 pg/mL. Based on the quartiles of IL-6 concentrations in the amniotic fluid, these women were divided into four subgroups (from the lowest to the highest IL-6 concentrations).
IL-6 concentrations in amniotic fluid were higher in women with acute histological chorioamnionitis (median: 819 pg/mL vs. 520 pg/mL; = .003) and with acute inflammation of the amnion (median: 1116 pg/mL vs. 533 pg/mL; = .0002) than in women without these complications. The rates of acute histological chorioamnionitis and acute inflammation of the amnion were the highest in the subgroup with IL-6 concentrations above the 75th percentile in amniotic fluid (chorioamnionitis, = .02; amnion, = .0002). No differences in IL-6 concentrations in amniotic fluid were identified between women with and without a fetal inflammatory response syndrome ( = .40). The rate of fetal inflammatory response syndrome did not vary among the amniotic fluid IL-6 quartile subgroups of women. Moreover, no differences were noted in short-term neonatal outcomes among the amniotic fluid IL-6 quartile subgroups.
A higher intensity of the intra-amniotic inflammatory response, measured by amniotic fluid IL-6 concentrations, is associated with a higher rate of acute inflammatory lesions in the placenta in the subset of PPROM pregnancies without microbial invasion of the amniotic cavity and intra-amniotic inflammation.
入院时羊膜腔无微生物侵入且无羊膜腔内炎症是早产胎膜早破（PPROM）最常见的情况。尽管在该PPROM亚组中羊膜腔内炎症反应强度未超过羊膜腔内炎症诊断阈值，但羊膜腔内炎症反应强度在结局方面是否存在差异仍不清楚。因此，本研究针对无羊膜腔微生物侵入及羊膜腔内炎症的PPROM的主要目的是：（i）根据羊水白细胞介素（IL）-6浓度测定羊膜腔内炎症反应强度与急性组织学绒毛膜羊膜炎及羊膜急性炎症之间的关联；（ii）描述羊膜腔内炎症反应强度与胎儿炎症反应之间的关联；（iii）根据羊膜腔内炎症反应强度描述婴儿的短期发病率。
本回顾性研究纳入了131例单胎妊娠且发生PPROM的女性，她们在孕24⁺⁰至36⁺⁶周之间，羊膜腔无微生物侵入且无羊膜腔内炎症，胎膜破裂后72小时内分娩。基于培养和非培养方法的组合评估羊膜腔微生物侵入情况。根据羊水IL-6浓度对羊膜腔内炎症进行特征描述。此外，对胎盘进行组织病理学评估。根据脐带血中IL-6浓度>11 pg/mL来定义胎儿炎症反应综合征。根据羊水中IL-6浓度的四分位数，将这些女性分为四个亚组（从最低IL-6浓度到最高）。
急性组织学绒毛膜羊膜炎女性（中位数：819 pg/mL对520 pg/mL；P = 0.003）和羊膜急性炎症女性（中位数：1116 pg/mL对533 pg/mL；P = 0.0002）的羊水IL-6浓度高于无这些并发症的女性。羊水IL-6浓度高于第75百分位数的亚组中，急性组织学绒毛膜羊膜炎和羊膜急性炎症的发生率最高（绒毛膜羊膜炎，P = 0.02；羊膜，P = 0.0002）。有胎儿炎症反应综合征和无胎儿炎症反应综合征的女性羊水IL-6浓度无差异（P = 0.40）。胎儿炎症反应综合征的发生率在女性羊水IL-6四分位数亚组之间无变化。此外，羊水IL-6四分位数亚组之间的短期新生儿结局无差异。
在无羊膜腔微生物侵入及羊膜腔内炎症的PPROM妊娠亚组中，以羊水IL-6浓度衡量的羊膜腔内炎症反应强度越高，胎盘急性炎症病变的发生率越高。
