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Fan X, Ma Y, Zhu Y, Tang W, Dong X, Liu M. The potential presence of infection may be indicated through non-invasive prediction of procalcitonin and C-reactive protein levels within the initial three days after cervical cerclage: a retrospective case-control study. BMC Pregnancy Childbirth 2024; 24:474. [PMID: 38992621 PMCID: PMC11241998 DOI: 10.1186/s12884-024-06668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE To identify which non-invasive infection indicators could better predict post-cervical cerclage (CC) infections, and on which days after CC infection indicators should be closely monitored. METHODS The retrospective, single-center study included 619 single-pregnancy patients from January 2021 to December 2022. Patients were categorized into infected and uninfected groups based on physicians' judgments of post-CC infections. Registered information included patient characteristics, cervical insufficiency history, gestational age at CC, surgical method (McDonald/Shirodkar), purpose of CC, mid-pregnancy miscarriage/preterm birth, infection history or risk factors, and infection indices on days 1, 3, 5, and 7 after CC. Propensity score matching (PSM) was applied to reduce patient characteristic bias. Statistical analysis of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), percentage of neutrophil count (NEU_P), interleukin-6 (IL-6), and procalcitonin (PCT) in the infected group compared with the uninfected group was performed using chi-square tests and t-tests. Receiver operating characteristic (ROC) curves were used to further assess the diagnostic value of CRP, PCT, and CRP-PCT in combination. RESULTS Among the 619 included patients, 206 patients were matched using PSM and subsequently assessed. PCT values on day 1 and day 3 after CC exhibited significant differences between the two groups in two statistical ways (P < 0.01, P < 0.05). The CRP levels on day 1 were significantly higher in the infected group compared to the uninfected group in two statistical ways (P < 0.05). On day 3, the mean CRP value was significantly elevated in the infected group compared to the uninfected group (P < 0.05). Analyses of IL-6, WBC, NEU, and NEU_P did not yield clinically significant results. The area under the ROC curves for CRP, PCT, and CRP-PCT on day 1 and day 3 were all below 0.7. In the preventive CC group, the AUC values of CRP and CRP-PCT obtained on d1 were found to be higher than 0.7, indicating moderate diagnostic accuracy. CONCLUSION For women after CC surgery, especially of preventive aim, increased serum CRP and PCT levels from post-CC day 1 to day 3 may signal a potential postoperative infection, warranting close monitoring.
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Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yabin Ma
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yunxia Zhu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Weijun Tang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
| | - Ming Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
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Temur I, Temur KT, Donertas SN, Dönertas AD. The relationships of inflammatory blood markers with maternal periodontal and dental states and their effects on preterm membrane rupture development. BMC Oral Health 2024; 24:652. [PMID: 38835011 DOI: 10.1186/s12903-024-04427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The influence of maternal oral and dental health on the occurrence of Preterm Premature Rupture of Membranes (P-PROM) and its underlying mechanisms remain uncertain. This research seeks to investigate the impact of maternal oral and dental health on the incidence of P-PROM and its association with inflammatory markers in the blood. METHODS This study adopts a prospective case-control design methodology. The study involved 70 women diagnosed with P-PROM and delivered by an obstetrician and 79 women who had healthy deliveries with no prenatal complications. The values for DMFT (Number of decayed, missing and filled teeth) index, Gingival Index (GI), Plaque index (PI), Pocket depth (PD), Clinical attachment loss (CAL) and medical history were recorded. Mann-Whitney U test and hierarchical binomial logistic regression analysis were applied. It was considered statistically significant at p < 0.05. RESULTS The case group's DMFT, PI, GI, PD values were statistically significantly higher than the control group (p < 0.001). There was no relationship between DMFT, GI, PD, CAL and inflammatory blood markers (p > 0.05). In the regression analysis for possible risk factors that may be effective in P-PROM, oral and dental health parameters were the most effective. CONCLUSIONS Oral and dental health of women with P-PROM was found to be worse than that of the control group. Oral and dental health may be a potential risk factor that may contribute to adverse pregnancy outcomes associated with P-PROM.
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Affiliation(s)
- Isa Temur
- Department of Obstetrics and Gynecology, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Katibe Tugce Temur
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Niğde Ömer Halisdemir University, Niğde, Turkey.
| | - Safak Necati Donertas
- Department of Periodontology, Faculty of Dentistry, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Aycan Dal Dönertas
- Department of Pedodontics, Faculty of Dentistry, Niğde Ömer Halisdemir University, Niğde, Turkey
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Lv Y, Huang Z, Ma Y. Association Analysis Between Maternal Neutrophil Ratio and the Risk of Histological Chorioamnionitis in Pregnant Women with Premature Rupture of Membranes in Late Pregnancy. Int J Gen Med 2024; 17:1499-1508. [PMID: 38660144 PMCID: PMC11041981 DOI: 10.2147/ijgm.s457645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Background We aimed to investigate the association between maternal neutrophil ratio and histological chorioamnionitis (HCA) risk in pregnant women with premature rupture of membranes (PROM) in late pregnancy. Methods A retrospective analysis was conducted on 95 cases of women with PROM in their late pregnancy between March 2018 and August 2021. These women were divided into two groups based on the presence of HCA. General clinical data and laboratory indicators were compared between the two groups. A generalized additive model was used for curve fitting, and a segmented regression model was used to explain further the non-linear relationship between neutrophil ratio and HCA risk. Results After adjusting for confounding factors, the curve fitting showed a "U"-shaped curve relationship between the neutrophil ratio and the risk of HCA. When the neutrophil ratio was <76.3%, the risk of HCA exhibited a decreasing trend, but the difference was not statistically significant (adjusted OR = 0.884, 95% CI: 0.781-1.001, P = 0.053). However, when the neutrophil ratio was >76.3%, the HCA risk was significantly increased (adjusted OR = 1.339, 95% CI: 1.067-1.680, P = 0.012). Furthermore, we equally divided the neutrophil ratio into three groups. The risk of HCA was significantly increased in the low-ratio group (OR = 4.292, 95% CI: 1.247-14.706, P = 0.021) compared with the middle-ratio group, which was used as the reference group. Similarly, the HCA risk of the high-ratio group (OR = 13.145, 95% CI: 1.796-96.233, P = 0.011) was also significantly enhanced. However, there was no significant difference in HCA risk between the high-ratio and low-ratio groups (OR = 1.182, 95% CI: 0.357-3.909, P = 0.784). Conclusion There was a significant "U"-shaped relationship between maternal neutrophil ratio and HCA risk in women with PROM in late pregnancy.
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Affiliation(s)
- Yan Lv
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
| | - Zheren Huang
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
| | - Yan Ma
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
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Wang X, Huang Z, Ma Y. Development and Validation of a Multivariable Predictive Model for the Risk of Histologic Chorioamnionitis in Patients with Premature Rupture of Membranes in the Late Preterm and Term. Int J Gen Med 2024; 17:141-152. [PMID: 38249617 PMCID: PMC10799642 DOI: 10.2147/ijgm.s445374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Background This study aimed to develop and validate a model to predict histologic chorioamnionitis (HCA) risk in late preterm and term premature rupture of membranes (PROM) patients using clinical and laboratory parameters. Methods We conducted a retrospective study on 116 late preterm and term PROM cases, divided into a training (n=81) and a validation set (n=35). A multivariable logistic regression model was developed using the training set. Performance was assessed via the area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI). Decision curve analysis (DCA) evaluated the model's clinical utility. Additionally, nomograms and a web version of the model were developed. Results In the training set, the combined model constructed using maternal BMI, gravidity, amniotic fluid characteristics, and prenatal white blood cell (WBC) count showed significantly higher AUC than WBC alone (0.859 vs 0.710, P=0.010), with improved accuracy and sensitivity. In the validation set, the AUC of the combined model remained higher than that of WBC, but the difference was not statistically significant (0.728 vs 0.584, P=0.173). NRI analysis indicated that the combined model improved the correct classification of HCA by 25.0% (P=0.012) compared to that of WBC alone. DCA demonstrated that the combined model had a higher net benefit than WBC in most cases. The nomograms and web version of the model provided convenient tools for clinicians to predict the risk of HCA. Conclusion This study successfully developed and validated a clinically feasible multivariable model to predict the risk of HCA in women with late preterm and term PROM.
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Affiliation(s)
- Xinshui Wang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
| | - Zheren Huang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
| | - Yan Ma
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China
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Xu C, Fan C, Zhang J, Zeng X, Fan Y, Feng S. Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study. BMC Pregnancy Childbirth 2023; 23:766. [PMID: 37919654 PMCID: PMC10621168 DOI: 10.1186/s12884-023-06026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia. METHODS A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves. RESULTS The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p < 0.0001). Based on the ROC curves, the following thresholds were selected to define increased laboratory indicators for identifying acute HCA: CRP ≥ 6.90 mg/L, NLR ≥ 11.93, and MLR ≥ 0.57. In addition, the AUC of the best logistic regression model predicting HCA ≥ stage 2 was 0.710, so these inflammatory markers were more precise in predicting HCA ≥ stage 2. CONCLUSION Increased CRP (≥ 6.90 mg/L), NLR (≥ 11.93), and MLR (≥ 0.57) may help clinicians to identify early potential acute HCA in febrile parturients receiving epidural analgesia and to monitor progression to optimize clinical treatment options. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry on November 24, 2021 ( http://www.chictr.org.cn , ChiCTR2100053554).
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Affiliation(s)
- Chenyang Xu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Chong Fan
- Department of Emergency, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Jingjing Zhang
- Department of Delivery Room, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Xin Zeng
- Department of Medical Research Center, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
| | - Yuru Fan
- Department of Delivery Room, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
| | - Shanwu Feng
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
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Prabhu M, Wilkie G, MacEachern M, LaBuda D, Purtell J, Rao K, Riley LE, Fuller M, Rosser M, Habib AS, Bauer ME. Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies. Int J Gynaecol Obstet 2023; 163:484-494. [PMID: 37118923 DOI: 10.1002/ijgo.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The utility of procalcitonin to identify obstetric sepsis is unknown. OBJECTIVE To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3). SEARCH STRATEGY NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022. SELECTION CRITERIA Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities. DATA COLLECTION AND ANALYSIS Each abstract and full-text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle-Ottawa Scale. A meta-analysis was performed using a random effects model. MAIN RESULTS The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta-analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036-0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049-0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005-1.292 ng/mL). CONCLUSIONS Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non-pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non-pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities. PROSPERO CRD42020157376, registered 4/28/2020.
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Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Gianna Wilkie
- Department of Obstetrics & Gynecology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | | | - Dana LaBuda
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Krishna Rao
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura E Riley
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Fuller
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Morgan Rosser
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Melissa E Bauer
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Li L, Huang X, Yan J, Zhang J, Yang D, Pan M. Predictive value of serum inflammatory markers for histological chorioamnionitis among women with preterm premature rupture of membranes after undergoing cervical cerclage. Clinics (Sao Paulo) 2023; 78:100292. [PMID: 37879248 PMCID: PMC10618699 DOI: 10.1016/j.clinsp.2023.100292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE To determine the predictive value of maternal White Blood Cells (WBC), neutrophils, and C-Reactive Protein (CRP) for diagnosing Histological Chorioamnionitis (HCA) among women with Preterm Premature Rupture of Membranes (PPROM) who underwent cervical cerclage. METHODS A retrospective cross-sectional study was conducted among women with singleton pregnancy and PPROM, who underwent cervical cerclage during 2018-2020. RESULTS A total of 55 eligible women were included in the final analysis, including 36 (61.02%) cases with HCA and 19 (38.98%) without HCA. Women with HCA had higher WBC count (12.31 ± 2.80) × 109/L and neutrophil count (9.67 ± 2.90)×109/L than those without HCA (10.35 ± 2.53) × 109/L and 7.82 ± 2.82 × 109/L, respectively) (both p < 0.05). The cut-off value of WBC count at 10.15×109/L was found to be the most effective in identifying HCA, with an Area Under Curve (AUC) of 0.707 (95% CI: 0.56-0.86; p = 0.012), sensitivity of 86.11%, specificity of 57.90%, Positive Predictive Value (PPV) of 79.49%, Negative Predictive Value (NPV) of 68.75%, and Youden index of 0.44. The combination of WBC + neutrophil had a slightly higher (AUC = 0.711, 95% CI: 0.57-0.86; p = 0.011), specificity (68.42%), and PPV (81.25%), but lower sensitivity (72.22%), than the WBC count alone. A cut-off value of neutrophil at 7.46 × 109/L was effective in identifying HCA, with an AUC of 0.689 (95% CI: 0.53-0.84; p = 0.022). DISCUSSION Combination use of WBC+neutrophil was found to be the most accurate predictor of HCA among women with PPROM after surgery of cervical cerclage.
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Affiliation(s)
- Li Li
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xinxin Huang
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jianying Yan
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jun Zhang
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Danlin Yang
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Mian Pan
- Department of Obstetrics, Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, China.
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Zhang L, Fang X, Li Z, Han X, Du H, Qu P, Xu F, Wu L, Li Y. Establishment of a prediction model for histological chorioamnionitis and its association with outcomes of premature infants. Front Pediatr 2023; 11:1194563. [PMID: 37654686 PMCID: PMC10466889 DOI: 10.3389/fped.2023.1194563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Aim This study aims to construct a prediction model for histological chorioamnionitis (HCA) and analyze the associations between the predicted risk of HCA and adverse outcomes in preterm infants. Methods In total, 673 subjects were included in this cohort study and divided into HCA group (n = 195) and non-HCA group (n = 478). A stepwise method was used to screen the predictors for HCA, binary logistic regression was used to construct the prediction model, and the associations between the predicted risk of HCA and adverse outcomes were analyzed. Results HCA occurred in 195 patients, accounting for 29.0%. The sensitivity of the prediction model was 0.821 [95% confidence interval (CI): 0.767-0.874)], the specificity was 0.684 (95% CI: 0.642-0.726), the positive predictive value was 0.514 (0.459-0.570), the negative predictive value was 0.903 (95% CI: 0.873-0.934), the area under the curve was 0.821 (95% CI: 0.786-0.855), and the accuracy was 0.724 (95% CI: 0.690-0.757). The predicted risk of HCA was associated with a higher risk of bronchopulmonary dysplasia (BPD) [odds ratio (OR) = 3.48, 95% CI: 1.10-10.95)], sepsis (OR = 6.66, 95% CI: 2.17-20.43), and neonatal infections (OR = 9.85, 95% CI: 3.59-26.98), but not necrotizing enterocolitis (OR = 0.67, 95% CI: 0.24-1.88), retinopathy of prematurity (OR = 1.59, 95% CI: 0.37-6.85), and brain damage (OR = 1.77, 95% CI: 0.82-3.83). After adjusting for confounders including gestational week at birth and birth weight, the risk of neonatal infections (OR = 5.03, 95% CI: 2.69-9.41) was increased in preterm infants' exposure to HCA. Conclusion The model showed good predictive performance for identifying pregnant women with a higher risk of HCA. In addition, HCA was associated with the risk of BPD, sepsis, and infections in neonates.
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Affiliation(s)
- Li Zhang
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Xin Fang
- Graduate School of Xi’an Medical University, Xi’an, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Xiang Han
- Department of Obstetric, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Hongyan Du
- Department of Pathology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Feifei Xu
- Graduate School of Xi’an Medical University, Xi’an, China
| | - Lizhi Wu
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Yajun Li
- Department of Neonatology, Northwest Women’s and Children’s Hospital, Xi’an, China
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Peng J, Chen Y, Wan S, Zhou T, Chang YS, Zhao X, Hua X. Predictors for histological chorioamnionitis among women with preterm prelabour rupture of membranes after dexamethasone treatment: a retrospective study. BJOG 2023; 130:1072-1079. [PMID: 36808206 DOI: 10.1111/1471-0528.17431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To investigate reliable biomarkers for predicting histological chorioamnionitis (HCA) in women with preterm prelabour rupture of membranes (PPROM). DESIGN A retrospective study. SETTING A maternity care hospital in Shanghai. POPULATION Women with PPROM before 34+0/7 weeks of gestation. METHODS Mean values of biomarkers were compared by two-way analysis of variance (ANOVA). Log-binomial regression models were used to assess the association between biomarkers and risk of HCA. A stepwise logistic regression model was used to develop a multi-biomarker prediction model and identify the independent predictors. The area under the receiver operating characteristic curve (AUC) was used to assess prediction performance. MAIN OUTCOME MEASURES The ability of the individual biomarker and the combination of multiple biomarkers to predict HCA. RESULTS In 157 mothers with PPROM, 98 (62.42%) women had HCA and 59 (37.58%) women did not have HCA. No significant differences were observed between the two groups in white blood cell, neutrophil or lymphocyte counts, whereas both high-sensitivity C-reactive protein (hsCRP) and procalcitonin (PCT) were significantly higher in the HCA group. HsCRP and PCT were found to be independently associated with the risk of HCA, and PCT had a larger AUC value than hsCRP (p < 0.05). The optimal multi-biomarker prediction model for HCA (AUC = 93.61%) included hsCRP at 72 hours and PCT at 48 and 72 hours, and PCT had a stronger prediction capacity than hsCRP. CONCLUSIONS PCT could be a reliable biomarker for the early prediction of HCA in women with PPROM within 72 hours of dexamethasone treatment.
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Affiliation(s)
- Jing Peng
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Chen
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Wan
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianfan Zhou
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu-Sin Chang
- Department of Mathematics, Milwaukee School of Engineering, Milwaukee, USA
| | - Xiaobo Zhao
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaolin Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Ehrlich Z, Magen S, Alexandroni H, Glik I, Grisaru-Granovsky S, Reichman O. The yield of procalcitonin and Interleukin-6 in predicting intraamniotic infection in the presence of intrapartum fever: A pilot study. PLoS One 2023; 18:e0288537. [PMID: 37437055 DOI: 10.1371/journal.pone.0288537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
Intrapartum fever (IF) accompanied by either maternal or foetal tachycardia, elevated WBC, or purulent discharge is classified as "suspected triple 1", the hallmark of intraamniotic infection (IAI). Poor specificity of the clinical diagnosis of IAI results, in retrospect, in the unnecessary treatment of most parturients and neonates. We studied the yield of specific acute phase reactants (APRs): procalcitonin, CRP, IL-6, in detecting bacterial IAI among parturients classified as "suspected triple 1" (cases) compared to afebrile parturients (controls). Procalcitonin, CRP, and IL-6 were all significantly elevated in the cases compared to the controls, yet this by itself was not sufficient for an additive effect in detecting a bacterial infection among parturients clinically diagnosed with "suspected triple 1", as demonstrated by the poor area under the receiver operating characteristic curve of all three APRs.
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Affiliation(s)
- Zvi Ehrlich
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Sophia Magen
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Heli Alexandroni
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Itamar Glik
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Orna Reichman
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
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12
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Wilkie GL, James K, Ona S, Easter SR, Chou J, Roberts D, Sahin ZO, Tuomala R, Diouf K, Riley L, Prabhu M. Innovating Evaluation and Treatment of Intrapartum Fevers: Where Do We Go from Here? Am J Perinatol 2023; 40:250-254. [PMID: 33878764 DOI: 10.1055/s-0041-1727279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
As intrapartum fevers are not always infectious in origin, determining whether antibiotics are indicated is challenging. We previously sought to create a point-of-care calculator using clinical data available at the time of an intrapartum fever to identify the subset of women who require antibiotic treatment to avoid maternal and neonatal morbidity. Despite the use of a comprehensive dataset from our institutions, we were unable to propose a valid and highly predictive model. In this commentary, we discuss why our model failed, as well as future research directions to identify and treat true intraamniotic infection. Developing a risk-stratification model is paramount to minimizing maternal and neonatal exposure to unnecessary antibiotics while allowing for early identification of women and babies at risk for infectious morbidity. KEY POINTS: · Determining whether antibiotics are indicated in intrapartum fever is challenging.. · Developing a risk-stratification model for febrile laboring women is critical to decreasing harm.. · A point-of-care calculator based on clinical and biomarker data is the necessary approach..
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Affiliation(s)
- Gianna L Wilkie
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samsiya Ona
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah Rae Easter
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Chou
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Drucilla Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zehra Ordulu Sahin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Tuomala
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Khady Diouf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York
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13
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Impact of elevated first and second trimester white blood cells on prevalence of late-onset preeclampsia. Heliyon 2022; 8:e11806. [DOI: 10.1016/j.heliyon.2022.e11806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/02/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
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14
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Shi H, Sun L, Wang Z, Zhang A, Cao H, Zhao W, Wang H, Yang X, Li J. Non-invasive prediction of histologic chorioamnionitis using maternal serum markers in women with preterm prelabour rupture of membranes. Am J Reprod Immunol 2022; 88:e13594. [PMID: 35789007 DOI: 10.1111/aji.13594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
PROBLEM This study aimed to evaluate and compare the predictive accuracy of serum markers for histological chorioamnionitis (HCA) among women with preterm prelabour rupture of membranes (PPROM), and to develop a nomogram prediction model to minimize the damage of the disease. METHOD OF STUDY This case-control study included 153 pregnant women with PPROM with a gestational age of 20+0 ∼ 36+6 weeks. The subjects were assigned into two groups: PPROM with and without HCA. According to the results of Logistic regression analysis, the predictive equation and nomogram were generated using key parameters, and the discrimination and consistency of the model were evaluated by receiver operating characteristic (ROC) curves and calibration curves. RESULTS From 153 subjects with PPROM, 77 developed HCA. Compared with the PPROM without HCA group, the CRP, PCT and NLR were significantly higher in HCA group (P<0.001), and the CRP had the highest predictive value. The area under the curve (AUC) of the prediction model was 0.873, and the sensitivity and specificity of predicting HCA were 68.8% and 92.1%, respectively. And the calibration curves fitted well with the realistic situation. CONCLUSION Maternal serum CRP and NLR could be used as predictive biomarkers for HCA in women with PPROM, while PCT needs to be further explored due to its slightly lower predictive value. Our serum markers and gestational age at PPROM could be used as a non-invasive and convenient method to predict HCA in women with PPROM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Haoning Shi
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China.,School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Lingling Sun
- Weifang Maternal and Child Health Hospital, Weifang, Shandong Province, PR China
| | - Zhenjie Wang
- Weifang People's Hospital, Weifang, Shandong Province, PR China
| | - Aimei Zhang
- Weifang People's Hospital, Weifang, Shandong Province, PR China
| | - Huaiming Cao
- Weifang Maternal and Child Health Hospital, Weifang, Shandong Province, PR China
| | - Wanying Zhao
- School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Hongyu Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Jing Li
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China.,School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
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15
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Ölmez F, Oğlak SC, Can E. The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes. Z Geburtshilfe Neonatol 2022; 226:233-239. [PMID: 35508193 DOI: 10.1055/a-1808-1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes. MATERIAL AND METHODS We conducted this prospective case-control study from January 2020 to June 2020. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index. RESULTS Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity. CONCLUSION Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.
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Affiliation(s)
- Fatma Ölmez
- Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Esra Can
- Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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16
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Can E, Oğlak SC, Ölmez F. Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes. J Obstet Gynaecol Res 2022; 48:1740-1749. [PMID: 35411577 DOI: 10.1111/jog.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/06/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to describe the maternal and fetal outcomes associated with expectant management following previable preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. We also analyzed the risk estimates of potential confounders to clarify whether these variables are contributed to the risk of postnatal mortality among these neonates. METHODS This retrospective cohort study included all pregnant patients who experienced previable PPROM before 24 weeks of gestation at a tertiary maternal-fetal medicine center. We used the neonatal data from birth until discharge. RESULTS A total of 128 women were enrolled. The survival to discharge rate was 60.9%. The median latency period (80 vs. 20 days, respectively, p < 0.001) was significantly longer, the median gestational week at delivery (34 vs. 25 weeks, respectively, p < 0.001) and median birth weight (2100 vs. 710 g, p < 0.001) was significantly higher in the survivor group than the non-survivor group. Surviving neonates had significantly lower frequencies of anhydramnios at any time during the latency period than the non-survivor neonates (38.4% vs. 86.0%, respectively, p < 0.001). CONCLUSION This study demonstrated an opposite correlation between the duration of latency period and gestational age at PPROM with earlier membrane rupture in pregnancies having a longer latency period, which additionally clarifies the higher gestational age at delivery. The antepartum factors that increased the possibility of postnatal mortality within our study included the gestational week at delivery, duration of the latency period, anhydramnios at any time during the latency period, and birth weight.
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Affiliation(s)
- Esra Can
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Fatma Ölmez
- Department of Obstetrics and Gynecology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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17
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Zhou S, Mei L, Zhou W, Yang Y, Zhang X, Mu X, Quan Q, Wang L. Clinical Factors and Perinatal Outcomes Associated With Short Latency Period in Twin Pregnancies With Preterm Premature Rupture of Membranes Before 34 Weeks: A Retrospective Study. Front Med (Lausanne) 2022; 9:839240. [PMID: 35308543 PMCID: PMC8931478 DOI: 10.3389/fmed.2022.839240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is a lack of literature on short latency period (SLP) in twin pregnancies with preterm premature rupture of membranes (PPROM). Thus, the aim of this study was to identify the clinical factors and perinatal outcomes associated with SLP in twin pregnancies with PPROM and to establish a predictive model to identify SLP. Methods Twin pregnancies with PPROM between 24 0/7 and 33 6/7 weeks were included and a retrospective analysis was performed. Patients were divided into two groups based on the latency period after PPROM: Group 1 ≤24 h (defined as SLP) and Group 2 >24 h (defined as long latency period, LLP), the clinical factors and perinatal outcomes were compared between the two groups. Binary logistic regression and receiver operating characteristic curve analyses were used to identify the independent clinical factors associated with latency period after PPROM and assess the predictive accuracy for SLP. Results 98 and 92 pregnant women had short and long latency period, respectively. Prolonged latency significantly increased the occurrence of chorioamnionitis. Neonatal outcomes were not affected by latency duration after PPROM. Binary regression analysis revealed that higher gestational age (GA) at PPROM (P = 0.038), presence of uterine contractions (P < 0.001), Bishop score > 4 (P = 0.030), serum procalcitonin levels ≥0.05 ng/mL upon admission, and absence of use of tocolytic agents (P < 0.001) were significant independent predictors of a SLP. A predictive model developed using these predictors had an area under the curve (AUC) of 0.838, and the presence of uterine contractions alone had an AUC of = 0.711. Conclusion Uterine contraction was the most important prognosticator for a SLP. A latency period of >24 h was associated with chorioamnionitis, but adverse neonatal outcomes were not observed.
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Affiliation(s)
- Shuwei Zhou
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Lingwei Mei
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Wei Zhou
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yajun Yang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoyan Zhang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Quan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Wang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Lan Wang
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18
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Farooqui R, Siddiqui QUA. Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of highvaginal swab as gold standard. Pak J Med Sci 2022; 38:310-314. [PMID: 35035445 PMCID: PMC8713219 DOI: 10.12669/pjms.38.1.4436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 08/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in Preterm premature rupture of the membranes (PPROM) with respect of high vaginal swab as gold standard Methods: A cross-sectional study was conducted at Liaquat National Hospital, Karachi, from February to August 2017. The blood sample of women with PPROM were collected to measure procalcitonin level. PCT1 and PCT2 were run along with the sample for the accuracy of the results. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of procalcitonin were calculated taking HVS C/S as gold standard. Results: Out of total 150 women, mean age was 28.78±4.79 years. Mean gestational age was 30.79±3.07 weeks. Mean procalcitonin level was 0.13±0.24 ng/ml. Intra-amniotic infection was diagnosed in 48.7% cases through procalcitonin levels and 51.3% through HVS culture and sensitivity. Sensitivity, Specificity, PPV (Positive predictive value), NPV (Negative predictive value) and accuracy were 87%, 91.8%, 91.78%, 87%, and 89.3% respectively. For females with gestational age ≤32 weeks, sensitivity, specificity, and diagnostic accuracy were 83.9%, 90.4%, and 87.03% respectively. For females with gestational age >32 weeks, sensitivity, specificity, and diagnostic accuracy were 95.2%, 92.5%, and 95.23% respectively. Conclusion: Diagnostic accuracy of maternal blood procalcitonin levels were found satisfactory in detection of early intra-amniotic infection in PPROM.
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Affiliation(s)
- Rabia Farooqui
- Dr. Rabia Farooqui, MBBS, FCPS. Senior Registrar, Department of Obstetrics & Gynaecology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Qurat-Ul-Aman Siddiqui
- Dr. Qurat-ul-Aman Siddiqui, MBBS, MCPS, FCPS. Associate Professor, Department of Obstetrics & Gynaecology, Australian Concept Infertility Medical Centre, Karachi, Pakistan. Liaquat National Hospital and Medical College, Karachi, Pakistan
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19
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Ang SX, Chen CP, Sun FJ, Chen CY. Bio-Functionalized Magnetic Nanoparticles for the Immunoassay of C-Reactive Protein and Procalcitonin in Cervicovaginal Secretions of Pregnant Women with Preterm Prelabor Rupture of Membranes to Predict Early-Onset Neonatal Sepsis. Int J Nanomedicine 2022; 17:287-297. [PMID: 35082495 PMCID: PMC8786349 DOI: 10.2147/ijn.s337691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/24/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose Early-onset sepsis is a major cause of neonatal morbidity and mortality. C-reactive protein (CRP) and procalcitonin (PCT) are acute phase reactants related to infection. The aim of this study was to explore the feasibility of measuring CRP and PCT concentrations in cervicovaginal secretions of pregnant women with preterm prelabor rupture of membranes (PPROM) using an immunomagnetic reduction (IMR) assay to predict early-onset neonatal sepsis. Patients and Methods This prospective study was performed at Mackay Memorial Hospital, Taipei, Taiwan from February 2015 to January 2018. Pregnant women with PPROM between 22 and 34 weeks of gestation were recruited. CRP and PCT concentrations in cervicovaginal secretions were measured using an IMR assay. Results Thirty-five cervicovaginal secretion samples were obtained. After excluding two neonatal deaths, early-onset neonatal sepsis was diagnosed in 15 of the 33 surviving neonates. There was no significant relationship between cervicovaginal secretion CRP level and neonatal sepsis; however, cervicovaginal secretion PCT levels were significantly higher in the neonatal sepsis group than in the non-sepsis group (45.99 vs 9.54 ng/mL, P = 0.039). Receiver operating characteristic (ROC) curve analysis revealed a PCT cut-off level of 20.60 ng/mL to predict early-onset sepsis, and the area under the ROC curve was 0.71 (95% confidence interval 0.52 to 0.90, P = 0.039), with sensitivity and specificity of 73.3% and 77.8%, respectively. Conclusion Measuring the concentration of PCT in cervicovaginal secretions with an IMR assay can predict early-onset sepsis in neonates born to mothers with PPROM.
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Affiliation(s)
- Sau Xiong Ang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chie-Pein Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Correspondence: Chen-Yu Chen Department of Obstetrics and Gynecology, Mackay Memorial Hospital, No. 92, Section 2, Zhong-Shan North Road, Taipei, 10449, TaiwanTel +886-2-2543-3535Fax +886-2-2543-3642 Email
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20
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Point F, Ghesquiere L, Drumez E, Petit C, Subtil D, Houfflin-Debarge V, Garabedian C. Risk factors associated with shortened latency before delivery in outpatients managed for preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand 2021; 101:119-126. [PMID: 34747005 DOI: 10.1111/aogs.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Preterm prelabor rupture of membranes (PPROM) occurs in 3% of pregnancies and is the main cause (~30%) of premature delivery. Home care seems to be a safe alternative for the management of patients with PPROM, who have a longer latency than those with PPROM managed with conventional hospitalization. We aimed to identify the risk factors associated with a shortened latency before delivery in women with PPROM managed as outpatients. MATERIAL AND METHODS The design was a retrospective cohort study and the setting was a Monocentric Tertiary centre (Lille University Hospital, France) from 2009 to 2018. All consecutive patients in home care after PPROM at 24-36 weeks were included. For the main outcome measure we calculated the latency ratio for each patient as the ratio of the real latency period to the expected latency period, expressed as a percentage. The risk factors influencing this latency ratio were evaluated. RESULTS A total of 234 patients were managed at home after PPROM. Mean latency was 35.5 ± 20.7 days, corresponding to an 80% latency ratio. In 196 (83.8%) patients the length of home care was more than 7 days. A lower latency ratio was significantly associated with oligohydramnios (p < 0.001), gestational age at PPROM (p = 0.006), leukocyte count at PPROM more than 12 × 109 /L (p = 0.025), and C-reactive protein concentration more than 5 mg/L at 7 days after PPROM (p = 0.046). Cervical length was not associated with a lower latency ratio. CONCLUSIONS Women with PPROM managed with home care are stable. The main risk factor associated with a reduced latency is oligohydramnios. Outpatients with oligohydramnios should be informed of the probability of a shortened latency period.
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Affiliation(s)
- Florian Point
- Department of Obstetrics, Lille University Hospital, Lille, France
| | | | - Elodie Drumez
- Department of Biostatistics, Lille University Hospital, Lille, France.,University of Lille, ULR 2694, Lille, France
| | - Céline Petit
- Department of Obstetrics, Lille University Hospital, Lille, France
| | - Damien Subtil
- Department of Obstetrics, Lille University Hospital, Lille, France.,University of Lille, ULR 2694, Lille, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Lille University Hospital, Lille, France.,University of Lille, ULR 2694, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, Lille University Hospital, Lille, France.,University of Lille, ULR 2694, Lille, France
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21
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Huang SY, Hsiao CH, Zhang XQ, Kang L, Yan JY, Cheng PJ. Serum procalcitonin to differentiate acute antepartum pyelonephritis from asymptomatic bacteriuria and acute cystitis during pregnancy: A multicenter prospective observational study. Int J Gynaecol Obstet 2021; 158:64-69. [PMID: 34597439 DOI: 10.1002/ijgo.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether serum procalcitonin (PCT) is useful for differentiating acute pyelonephritis (APN) from asymptomatic bacteriuria and acute cystitis during pregnancy. METHODS A multicenter prospective observational study was conducted to compare serum white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and PCT level among pregnant women with asymptomatic bacteriuria, acute cystitis, and APN and healthy pregnant women (controls). Utility of WBC count, ESR, CRP, and PCT biomarkers for the prediction of APN during pregnancy were measured. RESULTS Area under the curve (AUC) values of PCT, CRP, ESR, and WBC count for predicting asymptomatic bacteriuria were 0.576, 0.628, 0.542, and 0.532, respectively; those for predicting acute cystitis were 0.766, 0.735, 0.681, and 0.597, respectively; and those for predicting acute pyelonephritis 0.859, 0.763, 0.711, and 0.732, respectively. Compared with the other inflammatory markers used to predict APN, PCT exhibited the highest AUC (0.859 [95% confidence interval (CI) 0.711-0.935]). A cutoff value of >0.25 ng/ml had a sensitivity of 87% and a specificity of 79%. CONCLUSION Serum PCT can be a valuable addition to existing methods of differentiating asymptomatic bacteriuria, acute cystitis, and APN during pregnancy and can facilitate the early identification of APN during pregnancy.
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Affiliation(s)
- Shang-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hua Hsiao
- Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei, Taiwan.,Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Xue-Qin Zhang
- Department of Obstetrics, Women and Children's Hospital, Xiamen University, Xiamen, Fujian, China
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jian-Ying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
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22
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Chu YT, Hsu A, Wu CC, Tsai HD, Tsung-Che Hsieh C, Hsiao YH. Acute chorioamnionitis complicated with symmetrical peripheral gangrene. Taiwan J Obstet Gynecol 2021; 59:972-974. [PMID: 33218425 DOI: 10.1016/j.tjog.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Symmetrical peripheral gangrene (SPG) is an uncommon but important clinical syndrome. We present a case of acute chorioamnionitis complicated with SPG. CASE REPORT A 33-year-old female (gravida 5, para 2) was admitted with preterm premature rupture of membranes (PPROM) at 20 weeks and four days of gestation. She received cervical cerclage four days ago. Seven days after the diagnosis of PPROM, she developed fever, tachypnea and tachycardia. Termination of pregnancy was decided for clinical diagnosis of sepsis. After the abortus was born, gangrene change on the nose was noticed. Afterwards, this patient developed acrocyanosis of extremities. SPG developed following sepsis with intravascular disseminated coagulation (DIC). After intensive care, the patient underwent hyperbaric oxygen therapy and fasciectomy of the left forearm. CONCLUSION We suggest awareness of SPG associated with acute chorioamnionitis. Early recognition of SPG, multidisciplinary care, and treatment of its underlying conditions are the mainstays of management.
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Affiliation(s)
- Yi-Tzu Chu
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Alan Hsu
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chia-Chieh Wu
- Hyperbaric Oxygen Therapy Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Der Tsai
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | | | - Yi-Hsuan Hsiao
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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23
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İflazoğlu N, Eroğlu H, Tolunay HE, Yücel A. Comparison of the maternal serum endocan levels in preterm premature rupture of membrane and normal pregnancy. J Obstet Gynaecol Res 2021; 47:3151-3158. [PMID: 34109715 DOI: 10.1111/jog.14836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endocan is a novel marker of endothelial inflammation. In this study, we aimed to show whether there was a significant difference between the endocan levels of pregnant women with and without preterm premature rupture of membranes (PPROM and non-PPROM). Also, we aimed to find a relation between endocan levels and the latent period. MATERIAL AND METHODS Pregnant women with PPROM between 28 and 34 weeks of gestation and those without PPROM with similar gestational weeks were included in the study. A total of 88 pregnant women, 44 with PROM and 44 healthy pregnancies, were evaluated. Demographic and obstetric features, leukocyte, and endocan levels of the study and control groups were compared. RESULTS The demographic features and obstetric history of both groups were similar. The mean leukocyte and endocan levels of the study group were higher than in the control group (p < 0.001 and 0.029, respectively). The leukocyte level was the only independent factor predicting PPROM after multivariate logistic regression analysis. CONCLUSION Although the endocan levels were higher in patients with PPROM, multivariate analysis showed that the only independent predictive factor was the leukocyte level.
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Affiliation(s)
- Nuray İflazoğlu
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Hasan Eroğlu
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Harun Egemen Tolunay
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
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24
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Amadi M, Visentin S, Tosato F, Fogar P, Giacomini G, Res G, Bonadies L, Zaramella P, Plebani M, Cosmi E, Baraldi E. Neonatal lymphocyte subpopulations analysis and maternal preterm premature rupture of membranes: a pilot study. Clin Chem Lab Med 2021; 59:1688-1698. [PMID: 34087965 DOI: 10.1515/cclm-2021-0375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Preterm premature rupture of membranes (pPROM) causes preterm delivery, and increases maternal T-cell response against the fetus. Fetal inflammatory response prompts maturation of the newborn's immunocompetent cells, and could be associated with unfavorable neonatal outcome. The aims were (1) to examine the effects of pPROM on the newborn's and mother's immune system and (2) to assess the predictive value of immune system changes in neonatal morbidity. METHODS Mother-newborn pairs (18 mothers and 23 newborns) who experienced pPROM and controls (11 mothers and 14 newborns), were enrolled. Maternal and neonatal whole blood samples underwent flow cytometry to measure lymphocyte subpopulations. RESULTS pPROM-newborns had fewer naïve CD4 T-cells, and more memory CD4 T-cells than control newborns. The effect was the same for increasing pPROM latency times before delivery. Gestational age and birth weight influenced maturation of the newborns' lymphocyte subpopulations and white blood cells, notably cytotoxic T-cells, regulatory T-cells, T-helper cells (absolute count), and CD4/CD8 ratio. Among morbidities, fewer naïve CD8 T-cells were found in bronchopulmonary dysplasia (BPD) (p=0.0009), and more T-helper cells in early onset sepsis (p=0.04). CONCLUSIONS pPROM prompts maturation of the newborn's T-cell immune system secondary to antigenic stimulation, which correlates with pPROM latency. Maternal immunity to inflammatory conditions is associated with a decrease in non-major histocompatibility complex (MHC)-restricted cytotoxic cells.
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Affiliation(s)
- Margherita Amadi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Visentin
- Obstetrics and Gynecology Clinic, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Francesca Tosato
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Paola Fogar
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Giulia Giacomini
- Obstetrics and Gynecology Clinic, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giulia Res
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Patrizia Zaramella
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Erich Cosmi
- Obstetrics and Gynecology Clinic, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
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25
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Park S, Oh D, Heo H, Lee G, Kim SM, Ansari A, You YA, Jung YJ, Kim YH, Lee M, Kim YJ. Prediction of preterm birth based on machine learning using bacterial risk score in cervicovaginal fluid. Am J Reprod Immunol 2021; 86:e13435. [PMID: 33905152 DOI: 10.1111/aji.13435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/04/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022] Open
Abstract
PROBLEM Preterm birth (PTB) is a major cause of increased morbidity and mortality in newborns. The main cause of spontaneous PTB (sPTB) is the activation of an inflammatory response as a result of ascending genital tract infection. Despite various studies on the effects of the vaginal microbiome on PTB, a practical method for its clinical application has yet to be developed. METHOD OF STUDY In this case-control study, 94 Korean pregnant women with PTB (n = 38) and term birth (TB; n = 56) were enrolled. Their cervicovaginal fluid (CVF) was sampled, and a total of 10 bacteria were analyzed using multiplex quantitative real-time PCR (qPCR). The PTB and TB groups were compared, and a PTB prediction model was created using bacterial risk scores using machine learning techniques (decision tree and support vector machine). The predictive performance of the model was validated using random subsampling. RESULTS Bacterial risk scoring model showed significant differences (P < 0.001). The PTB risk was low when the Lactobacillus iners ratio was 0.812 or more. In groups with a ratio under 0.812, moderate and high risk was classified as a U. parvum ratio of 4.6 × 10-3 . The sensitivity and specificity of the PTB prediction model using bacteria risk score were 71% and 59%, respectively, and 77% and 67%, respectively, when white blood cell (WBC) data were included. CONCLUSION Using machine learning, the bacterial risk score in CVF can be used to predict PTB.
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Affiliation(s)
- Sunwha Park
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea
| | | | - Hanna Heo
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea
| | - Gain Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea.,System Health & Engineering Major in Graduate School (BK21 Plus Program, Seoul, Korea
| | - Soo Min Kim
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea.,System Health & Engineering Major in Graduate School (BK21 Plus Program, Seoul, Korea
| | - AbuZar Ansari
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea
| | - Young-Ah You
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea
| | - Yun Ji Jung
- Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Korea
| | | | - Young Ju Kim
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul, Korea.,System Health & Engineering Major in Graduate School (BK21 Plus Program, Seoul, Korea
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26
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Do SC, Miller H, Leonard SA, Datoc IA, Girsen AI, Kappagoda S, Gibbs RS, Aziz N. Lactate and procalcitonin levels in peripartum women with intraamniotic infection. Am J Obstet Gynecol MFM 2021; 3:100367. [PMID: 33831586 DOI: 10.1016/j.ajogmf.2021.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pregnant women are vulnerable to infection as their immune response is modulated. OBJECTIVE Serum biomarkers are used to diagnose and manage severe infections, but data on their utility during labor are limited. We compared lactate and procalcitonin levels in women with and without an intraamniotic infection to determine whether they are useful biomarkers for infection during labor. STUDY DESIGN We performed a prospective, observational cohort study of term, singleton pregnancies admitted with planned vaginal delivery in 2019 at a university medical center. The lactate and procalcitonin levels were determined during early labor, within 2 hours following delivery, and on postpartum day 1. Women with an intraamniotic infection in addition had their lactate and procalcitonin levels determined following an intraamniotic infection diagnosis. Samples were processed immediately in the hospital clinical laboratory. The primary outcome was the mean lactate level following delivery. The secondary outcomes were the lactate and procalcitonin levels at other time points. Comparisons based on infection status were performed using multivariate linear regressions. RESULTS A total of 22 women with intraamniotic infection and 29 uninfected women were included. The mean early labor lactate level (1.47 vs 1.49 mmol/L) and mean procalcitonin level (0.048 vs 0.039 ng/mL) did not differ and were normal in the uninfected and intraamniotic infection groups. The mean lactate level was highest following delivery for women in both the uninfected and intraamniotic infection groups (2.00 vs 2.33 mmol/L; adjusted P=.08; 95% confidence interval, 0.98-1.53). The lactate level returned to normal by postpartum day 1 and did not differ significantly based on the infection status at any time point in the adjusted models. The procalcitonin level following delivery was higher among women with vs without an intraamniotic infection (0.142 vs 0.091 ng/mL; adjusted P=.03). The procalcitonin level rose further in both the intraamniotic infection and uninfected groups on postpartum day 1 (0.737 vs 0.408 ng/mL; adjusted P=.05). CONCLUSION The lactate level is not significantly elevated in pregnant women with an intraamniotic infection above the physiological increase that is observed in women without infection at delivery. The procalcitonin level is elevated at delivery in women with an intraamniotic infection and warrants further investigation as a peripartum infection marker.
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Affiliation(s)
- Samantha C Do
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz); Maternal Fetal Medicine Associates, New York, NY (Dr Do).
| | - Hayley Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
| | - Stephanie A Leonard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
| | - Imee A Datoc
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
| | - Anna I Girsen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
| | - Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA (Dr Kappagoda)
| | - Ronald S Gibbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
| | - Natali Aziz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Do, Miller, Leonard, Datoc, Girsen, Gibbs, and Aziz)
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27
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Areia AL, Areia M, Mota-Pinto A. Procalcitonin in preterm rupture of membranes: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 303:917-924. [PMID: 33009995 DOI: 10.1007/s00404-020-05820-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Early detection of infection is of supreme importance in obstetrics; however, during pregnancy it is not reliably predicted by standard laboratory tests. We aimed to determine if procalcitonin (PCT) is a reliable predictor of chorioamnionitis (CA) in women with premature rupture of membranes (PPROM). METHODS An electronic search of Scopus, ISI, Medline, Embase, ClinicalTrials.gov and the Cochrane Library databases was performed using specified key words. We examined all English and French reports on PCT measurement after admission for PPROM and considered: human studies published between 1990 and 2019; observational studies; and randomized controlled trials. A protocol was determined previously, registered at PROSPERO as CRD42019145464. The eligibility was independently assessed by two researchers and literature search yielded 590 studies; after revision of the titles and abstracts, 46 articles were identified as potentially eligible; eight studies were included in the meta-analysis. Primary data synthesis was performed in Review Manager Version 5.3 and average sensitivity and specificity was calculated using Midas, Stata. RESULTS From the eight studies included, 335 participants with PPROM were enrolled. Our meta-analysis disclosed that PCT has a poor sensitivity (0.50; 95% CI 0.28-0.73) and a modest specificity (0.72; 95% CI 0.51-0.87) in diagnosing CA. C-reactive protein (CRP) not only has better sensitivity (0.71; 95% CI 0.53-0.84), but also better specificity (0.75; 95% CI 0.55-0.88), compared with the other inflammatory parameters analyzed. Procalcitonin does not seems to be better than CRP in preterm rupture of membranes for chorioamnionitis diagnosis.
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Affiliation(s)
- Ana Luísa Areia
- Obstetric Department, Centro Hospitalar e Universitário de Coimbra, Avenida Bissaya Barreto, 101-2B, 3000-076, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute, Coimbra, Portugal.,CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
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28
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Ma Y, Xu Y, Jiang L, Shao X. Application of a Prediction Model Based on the Laboratory Index Score in Prelabor Rupture of Membranes with Histologic Chorioamnionitis During Late Pregnancy. Med Sci Monit 2020; 26:e924756. [PMID: 32996472 PMCID: PMC7534503 DOI: 10.12659/msm.924756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to establish a prediction model based on the maternal laboratory index score (Lab-score) for histologic chorioamnionitis (HCA) in patients with prelabor rupture of membranes (PROM) during late pregnancy. Material/Methods Sixty-nine cases of pregnant women with PROM were retrospectively analyzed. The general information and laboratory indicators were compared between the HCA (n=22) and non-HCA (n=47) groups. A multivariate logistic regression method was used to establish the prediction model. We plotted the receiver operating characteristic curve and calculated the area under the curve (AUC). The clinical effectiveness of each model was compared by decision curve analysis. Results Only C-reactive protein (CRP) in the laboratory index predicted HCA, but its diagnostic efficacy was not ideal (AUC=0.651). Then, we added CRP to the platelet/white blood cell count ratio and triglyceride level to construct the Lab-score. Based on the Lab-score, important clinical parameters, including body mass index, diastolic blood pressure, and preterm birth, were introduced to construct a complex joint prediction model. The AUC of this model was significantly larger than that of CRP (0.828 vs. 0.651, P=0.035), but not significantly different from that of Lab-score (0.828 vs. 0.724, P=0.120). Considering the purpose of HCA screening, the net benefit of the complex model was better than that of Lab-score and CRP. Conclusions The complex model based on Lab-score is useful in the clinical screening of high-risk populations with PROM and HCA during late pregnancy.
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Affiliation(s)
- Yan Ma
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Yun Xu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Lijuan Jiang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
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29
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Etyang AK, Omuse G, Mukaindo AM, Temmerman M. Maternal inflammatory markers for chorioamnionitis in preterm prelabour rupture of membranes: a systematic review and meta-analysis of diagnostic test accuracy studies. Syst Rev 2020; 9:141. [PMID: 32532314 PMCID: PMC7293113 DOI: 10.1186/s13643-020-01389-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is no consensus on the role of inflammatory markers in identifying chorioamnionitis in preterm prelabour rupture of membranes (PPROM). We set out to evaluate the accuracy of maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) in diagnosis of histological chorioamnionitis and/or funisitis (HCA/Funisitis) in PPROM. METHODS We searched MEDLINE, EMBASE and The Cochrane Library from inception to January 2020 for studies where maternal blood CRP, procalcitonin or IL6 was assessed against a reference standard of HCA/Funisitis in PPROM. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess methodological quality. Hierarchical summary receiver operating characteristic (SROC) models were used to construct summary curves. Bivariate models were used to obtain summary estimates for studies with the same cut-off. RESULTS We included 23 studies reporting HCA/Funisitis in 902 of 1717 women, median prevalence 50% (inter-quartile range 38-57). Of these studies, 20 were prospective cohort design and 3 were retrospective cohort. Eleven studies reported the index test against a reference standard of HCA and/or funisitis, 10 reported HCA alone and 2 reported funisitis alone. Many studies had high risk of bias scores on the QUADAS-2 assessment but low concerns for applicability. Sensitivity and specificity for CRP ≥ 20 mg/L (5 studies, 252 participants) was 59% (95% CI 48-69) and 83% (95% CI 74-89) respectively. SROC curves are provided for each index test. At selected specificity of 80%, the sensitivities for CRP (all cut-offs, 17 studies, 1404 participants), PCT ( all cut-offs, 6 studies, 231 participants) and IL6 (all cut-offs, 5 studies, 299 participants) were 59%(95% CI 52-68), 56%(95% CI 50-69) and 52% (95% CI 50-86) respectively. CONCLUSIONS There is insufficient evidence to support use of CRP, procalcitonin or IL6 in maternal blood for diagnosis of HCA/Funisitis in PPROM. This review followed recommended methodology and data analytic methods that made the most of the data regardless of the different cut-offs used. However, the evidence is based on few studies with generally small sample sizes, poor-quality scores and substantial heterogeneity. There is a need for good-quality diagnostic accuracy studies to better assess the role of these biomarkers in PPROM. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42015023899, registered on 8 October 2015.
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Affiliation(s)
- Angela Koech Etyang
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Abraham Mwaniki Mukaindo
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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30
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Unal C, Karatas E, Fadıloglu E, Portakal O, Beksac MS. Comparison of term and preterm labor procalcitonin and leukocyte cell volume, conductivity and light scatter (VCS) parameters in order to demonstrate the impact of inflammation on the triggering mechanisms of preterm uterin contractions. J Obstet Gynaecol Res 2020; 46:694-698. [DOI: 10.1111/jog.14216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Canan Unal
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Esra Karatas
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Erdem Fadıloglu
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
| | - Oytun Portakal
- Department of BiochemistryHacettepe University Ankara Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatology, Department of Obstetrics and GynecologyHacettepe University Ankara Turkey
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