De Meeus J B, Pourrat O, Gombert J, Magnin G
Department of Obstetrics, Gynaecology and Reproductive Medicine, University Hospital Jean Bernard, Poitiers, France.
Clin Exp Obstet Gynecol. 1998;25(1-2):9-11.
To record maternal serum C-reactive protein levels during normal onset of labour and normal puerperium and to evaluate if inflammation or infection could be predicted during these two periods when serum C-reactive protein is increased.
Eighty-five pregnant women were enrolled in a longitudinal prospective study and had a blood sample to assess serum C-reactive protein levels on admission to the labour ward for normal onset of labour and at day three post-partum. Inclusion criteria were no previous history, a normal single pregnancy, normal vaginal delivery and an uneventful post-partum course. Twelve non-pregnant women of the same age constitued a control group. An automatic Behring Nephelometer was used to measure serum C-reactive protein concentrations. The Student's t-test (significance p < 0.05) was used for statistical analysis.
C-reactive protein was significantly increased during the onset of labour (4.10 +/- 2.79 mg/L) and reached very high levels during the post-partum period (24.07 +/- 18.28 mg/L) compared to the standard normal serum C-reactive protein level in a population of non-pregnant women of the same age (2.39 +/- 0.07 mg/L).
Increased serum C-reactive protein has been reported to be a marker for subclinical infection during pregnancy in various situations including premature labour and premature rupture of membranes and for complications occurring during puerperium such as thrombophlebitis, thromboembolism or endometritis. This interpretation depends on which upper limit is considered as abnormal. Because serum C-reactive protein was raised during the onset of labour, values of less than 10 mg/L could not be considered as a marker for infection during this period. Elevated serum concentrations of estrogen, progestogen and prostaglandins during labour might be one explanation for those physiological changes. Normal vaginal delivery could be compared to a surgical procedure and tissue injury consecutive to vaginal birth as reflected by a dramatic increase in C-reactive protein. More studies using nephelometry are needed to determine normal and upper values of C-reactive protein during pregnancy.
记录正常分娩开始时及正常产褥期的孕妇血清C反应蛋白水平，并评估在血清C反应蛋白升高的这两个时期是否能够预测炎症或感染。
85名孕妇纳入一项纵向前瞻性研究，在进入产房正常分娩时及产后第3天采集血样以评估血清C反应蛋白水平。纳入标准为无既往病史、单胎妊娠正常、阴道分娩正常且产后过程顺利。12名同龄非孕妇组成对照组。使用自动贝林散射比浊仪测量血清C反应蛋白浓度。采用Student's t检验（显著性p<0.05）进行统计分析。
与同龄非孕妇群体的标准正常血清C反应蛋白水平（2.39±0.07mg/L）相比，分娩开始时C反应蛋白显著升高（4.10±2.79mg/L），产后时期达到非常高的水平（24.07±18.28mg/L）。
据报道，血清C反应蛋白升高是多种情况下妊娠期间亚临床感染的标志物，包括早产和胎膜早破，也是产褥期发生的并发症如血栓性静脉炎、血栓栓塞或子宫内膜炎的标志物。这种解读取决于将哪个上限视为异常。因为分娩开始时血清C反应蛋白升高，在此期间低于10mg/L的值不能被视为感染的标志物。分娩期间雌激素、孕激素和前列腺素血清浓度升高可能是这些生理变化的一种解释。正常阴道分娩可与外科手术相比较，阴道分娩后组织损伤导致C反应蛋白急剧增加。需要更多使用散射比浊法的研究来确定妊娠期间C反应蛋白的值及上限。
