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Guo X, Wang Y, Obore N, Qian W, Yu H. Research Hotspots and Trends in the Diagnosis of Chorioamnionitis: Based on Bibliometric Analysis from 2010 to 2022. Am J Perinatol 2024; 41:e2159-e2167. [PMID: 37364595 DOI: 10.1055/s-0043-1770366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study aimed to conduct a bibliometric analysis of literature related to the diagnosis of chorioamnionitis (CAM) and to point out the current research progress, hotspots, and development trends of CAM research. STUDY DESIGN Literature on the diagnosis of CAM from the Web of Science Core Collection (WoSCC) between 2010 and 2022 was retrieved. CiteSpace, VOSviewer, and Online Analysis Platform (OALM) were used to draw maps of authors, articles, journals, institutions, countries/regions, and keywords. RESULTS A total of 312 articles were included, and the number of articles gradually increased over the study period. The author with the largest number of articles was Roberto Romero. The institution with the largest number of articles was Wayne State University School of Medicine, and the United States was the country that produced the largest number of articles. Analysis of keywords and outbreak words suggested that future research hotspots and trends may focus on early treatment of CAM and more precise, noninvasive, and more sensitive diagnoses. CONCLUSION In this study, visualization software and data information mining were innovatively used to conduct a bibliometric analysis of articles in the field of CAM diagnosis, and the current status, hotspots, and development of this field were obtained. Future research hotspots may be the precision diagnosis and treatment of CAM. KEY POINTS · There is no bibliometric study on CAM diagnosis in the existing literature.. · The prediction of CAM diagnosis is an important topic to improve maternal and infant prognosis.. · Bibliometrics can effectively guide the direction of future research..
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Affiliation(s)
- Xiaojun Guo
- Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
| | - YiXiao Wang
- Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
| | - Nathan Obore
- Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
| | - Wei Qian
- Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
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di Pasquo E, Fieni S, Chandraharan E, Dall'Asta A, Morganelli G, Spinelli M, Bettinelli ML, Aloe R, Russo A, Galli L, Perrone S, Ghi T. Correlation between intrapartum CTG findings and interleukin-6 levels in the umbilical cord arterial blood: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 294:128-134. [PMID: 38237311 DOI: 10.1016/j.ejogrb.2024.01.018] [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: 09/21/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE to investigate the correlation between the intrapartum CardioTocoGraphic (CTG) findings "suggestive of fetal inflammation" ("SOFI") and the interleukin (IL)-6 level in the umbilical arterial blood. STUDY DESIGN prospective cohort study conducted at a tertiary maternity unit and including 447 neonates born at term. METHODS IL-6 levels were systematically measured at birth from a sample of blood taken from the umbilical artery. The intrapartum CTG traces were retrospectively reviewed by two experts who were blinded to the postnatal umbilical arterial IL-6 values as well as to the neonatal outcomes. The CTG traces were classified into "suggestive of fetal inflammation (SOFI)" and "no evidence of fetal inflammation (NEFI) according to the principles of physiologic interpretation the CTG traces. The CTG was classified as "SOFI" if there was a persistent fetal heart rate (FHR) increase > 10 % compared with the observed baseline FHR observed at the admission or at the onset of labor without any preceding repetitive decelerations. The occurrence of Composite Adverse Outcome (CAO) was defined as Neonatal Intensive Care Unit (NICU) or Special Care Baby Unit (SCBU) admission due to one or more of the following: metabolic acidaemia, Apgar score at 5 min ≤ 7, need of neonatal resuscitation, respiratory distress, tachypnoea/polypnea, jaundice requiring phototherapy, hypotension, body temperature instability, poor perinatal adaptation, suspected or confirmed early neonatal sepsis. MAIN OUTCOME MEASURES To compare the umbilical IL-6 values between the cases with intrapartum CTG traces classified as "SOFI" and those classified as "NEFI"; to assess the correlation of umbilical IL-6 values with the neonatal outcome. RESULTS 43 (9.6 %) CTG traces were categorized as "SOFI"; IL-6 levels were significantly higher in this group compared with the "NEFI" group (82.0[43.4-325.0] pg/ml vs. 14.5[6.8-32.6] pg/mL; p <.001). The mean FHR baseline assessed 1 h before delivery and the total labor length showed an independent and direct association with the IL-6 levels in the umbilical arterial blood (p <.001 and p = 0.005, respectively). CAO occurred in 33(7.4 %) cases; IL-6 yielded a good prediction of the occurrence of the CAO with an AUC of 0.72 (95 % CI 0.61-0.81). CONCLUSION Intrapartum CTG findings classified as "SOFI" are associated with higher levels of IL-6 in the umbilical arterial blood.
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Affiliation(s)
- Elvira di Pasquo
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Stefania Fieni
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | | | - Andrea Dall'Asta
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy; Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Morganelli
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Marta Spinelli
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Laura Bettinelli
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosalia Aloe
- Unit of Blood Chemistry Diagnostics, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Annalisa Russo
- Unit of Blood Chemistry Diagnostics, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Letizia Galli
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Serafina Perrone
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tullio Ghi
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy; Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Carter SWD, Neubronner S, Su LL, Dashraath P, Mattar C, Illanes SE, Choolani MA, Kemp MW. Chorioamnionitis: An Update on Diagnostic Evaluation. Biomedicines 2023; 11:2922. [PMID: 38001923 PMCID: PMC10669668 DOI: 10.3390/biomedicines11112922] [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: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chorioamnionitis remains a major cause of preterm birth and maternal and neonatal morbidity. We reviewed the current evidence for the diagnostic tests of chorioamnionitis and how this relates to clinical practice today. A comprehensive literature search and review was conducted on chorioamnionitis and intra-uterine inflammation. Data from randomized control trials and systematic reviews were prioritized. This review highlights that sterile inflammation plays an important role in chorioamnionitis and that the current tests for chorioamnionitis including clinical criteria, maternal plasma and vaginal biomarkers lack diagnostic accuracy. Concerningly, these tests often rely on detecting an inflammatory response after damage has occurred to the fetus. Care should be taken when interpreting current investigations for the diagnosis of chorioamnionitis and how they guide obstetric/neonatal management. There is an urgent need for further validation of current diagnostic tests and the development of novel, accurate, minimally invasive tests that detect subclinical intra-uterine inflammation.
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Affiliation(s)
- Sean W D Carter
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Samantha Neubronner
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Pradip Dashraath
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Citra Mattar
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Sebastián E Illanes
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Center for Biomedical Research and Innovation, Reproductive Biology Program, Universidad de los Andes, Santiago 111711, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8331150, Chile
| | - Mahesh A Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore 117597, Singapore
| | - Matthew W Kemp
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA 6008, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
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Tsushima R, Iino K, Song S, Saito N, Tanaka K, Yokoyama Y. Chorioamnionitis and maternal sepsis caused by AmpC β-lactamase-producing Escherichia coli infection: A case report. Int J Surg Case Rep 2023; 111:108781. [PMID: 37708785 PMCID: PMC10507126 DOI: 10.1016/j.ijscr.2023.108781] [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: 08/08/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Multidrug resistant bacteria have increasingly become a concern regarding infection treatment. The clinical course of chorioamnionitis (CAM) caused by multidrug-resistant bacteria is not well understood. PRESENTATION OF CASE We report a case of CAM caused by AmpC-type β-lactamase (AmpC)-producing Escherichia coli (E. coli), a multidrug-resistant bacterium. A 35-year-old primipara was hospitalized with preterm membrane rupture at 36 weeks of gestation and was started on oral ampicillin. On the fourth day after admission, the patient was diagnosed with CAM owing to high fever development and uterine tenderness; therefore, an emergency cesarean section was performed. AmpC-producing E. coli were detected in blood and amniotic fluid cultures. Post-operation, the patient received treatment for septic shock and was discharged on the 15th post-operative day. DISCUSSION The patient initially had no symptoms of infection but later experienced fever and uterine pain. She underwent an emergency cesarean section, and both mother and baby were successfully treated with broad-spectrum antibiotics. CAM associated with multidrug-resistant bacteria is more challenging to manage compared to infections in other parts of the body, as it occurs in unique environments such as the uterus, during pregnancy, and in the presence of compromised immunity. CONCLUSION The development of new diagnostic criteria and effective biomarkers is needed to improve early detection, and adherence to standard precautions can help prevent the acquisition of multidrug-resistant bacteria in healthcare settings.
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Affiliation(s)
- Ryuto Tsushima
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan
| | - Kaori Iino
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan.
| | - Shuang Song
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan; Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Norihiro Saito
- Department of Clinical Laboratory Medicine, Hirosaki University Hospital, Hirosaki, 53 Honcho, Hirosaki, Aomori 036-8563, Japan; Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, 53 Honcho, Hirosaki, Aomori 036-8563, Japan
| | - Kanji Tanaka
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan
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Panneflek TJR, Kuypers KLAM, Polglase GR, Hooper SB, van den Akker T, Te Pas AB. Effect of clinical chorioamnionitis on breathing effort in premature infants at birth: a retrospective case-control study. Arch Dis Child Fetal Neonatal Ed 2022; 108:280-285. [PMID: 36418158 DOI: 10.1136/archdischild-2022-324695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE Antenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth. METHODS Infants with CCA born <30 weeks' gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia. The primary outcome was breathing effort, assessed as minute volume (MV) of spontaneous breathing. We also measured tidal volume (Vt), respiratory rate (RR) and apnoea in the first 5 min and additional physiological parameters in the first 10 min after start of respiratory support. RESULTS Ninety-two infants were included (n=46 CCA infants vs n=46 controls; median (IQR) gestational age 26+4 (25+0-27+6) vs 26+6 (25+1-28+3) weeks). MV and Vt were significantly lower (MV: 43 (17-93) vs 70 (31-119) mL/kg/min, p=0.043; Vt: 2.6 (1.9-3.6) vs 2.9 (2.2-4.8) mL/kg/breath, p=0.046), whereas RR was similar in CCA infants compared with controls. Incidence of apnoea was higher (5 (2-6) vs 2 (1-4), p=0.002), and total duration of apnoea was longer (90 (21-139) vs 35 (12-98) s, p=0.025) in CCA infants. CCA infants took significantly longer to reach an oxygen saturation >80% (3:37 (2:10-4:29) vs 2:25 (1:06-3:52) min, p=0.016) and had a lower oxygen saturation at 5 min (77 (66-92) vs 91 (68-94) %, p=0.028), despite receiving more oxygen (62 (48-76) vs 54 (43-73) %, p=0.036). CONCLUSION CCA is associated with reduced breathing effort and oxygenation in premature infants at birth.
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Affiliation(s)
- Timothy J R Panneflek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kristel L A M Kuypers
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Thomas van den Akker
- Department of Obstetrics, Leids Universitair Medisch Centrum, Leiden, the Netherlands.,Athena Institute, VU University, Amsterdam, the Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
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Maki Y, Sato Y, Furukawa S, Sameshima H. Histological severity of maternal and fetal inflammation is correlated with the prevalence of maternal clinical signs. J Obstet Gynaecol Res 2022; 48:1318-1327. [PMID: 35509239 DOI: 10.1111/jog.15241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/25/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether there is a stepwise increase in the prevalence of maternal clinical signs according to the severity of histological inflammation in the chorioamniotic membranes, placenta, and umbilical cord in preterm deliveries. METHODS This retrospective study, conducted between January 2007 and May 2017, included patients with preterm delivery between 22 and 33 weeks. The histological findings of maternal/fetal inflammatory responses were staged and graded according to the Amsterdam Placental Workshop Group consensus statement. Correlations between the histological severity of maternal/fetal inflammatory responses and the prevalence of clinical chorioamnionitis and clinical signs were evaluated using the Cochran-Armitage trend test. RESULTS A total of 138 patients were included. The stage and grade of the maternal inflammatory response were correlated with earlier gestational weeks at delivery and lighter birth weight. The prevalence of clinical chorioamnionitis was significantly correlated with a higher stage and grade of the maternal inflammatory response (Gibbs/Lencki criteria: 15.8%/15.8% in Stage 3, 16.3%/14% in Grade 2). No significant correlations were observed between gestational weeks at delivery and birth weight and stage/grade of fetal inflammatory response. The prevalence of clinical chorioamnionitis was significantly correlated with higher stage and grade of fetal inflammatory response (Gibbs/Lencki criteria: 25%/25% in Stage 3 and 29.4%/29.4% in Grade 2). CONCLUSION Correlations exist between the severity of histological maternal/fetal inflammatory responses and the prevalence of clinical chorioamnionitis and positive maternal clinical signs in preterm deliveries. However, the prevalence of clinical chorioamnionitis was 20%-30% even in the most severe fetal inflammatory responses.
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Affiliation(s)
- Yohei Maki
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Seishi Furukawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Balciuniene G, Gulbiniene V, Kvederaite-Budre G, Dumalakiene I, Viliene R, Pilypiene I, Drasutiene GS, Ramasauskaite D. A value of soluble Toll-like receptor 2 and 4 in vaginally obtained amniotic fluid for the prediction of histological chorioamnionitis. Acta Obstet Gynecol Scand 2021; 100:2209-2215. [PMID: 34244993 PMCID: PMC9291945 DOI: 10.1111/aogs.14228] [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: 03/15/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study was conducted to evaluate soluble Toll-like receptor 2 (sTLR-2) and soluble Toll-like receptor 4 (sTLR-4) levels in vaginally obtained amniotic fluid and investigate their value in the prediction of histological chorioamnionitis (HCA). MATERIAL AND METHODS This prospective case-control study included patients who had been diagnosed with preterm premature rupture of membranes before 34 weeks of gestation and were admitted to Vilnius University Hospital Santaros Klinikos. Free leaking amniotic fluid was obtained vaginally using a sterile speculum up to 48 h before delivery. Amniotic fluid levels of sTLR-2 and sTLR-4 were determined using an enzyme-linked immunosorbent assay. The diagnosis of chorioamnionitis was confirmed by histological examination of the placenta and membranes after delivery. RESULTS The study included 156 patients, 65 with (HCA Group) and 91 without (non-HCA Group) HCA. No statistically significant differences were noted in the concentrations of sTLR-2 and sTLR-4 in vaginally obtained amniotic fluid between patients with and without HCA: the median sTLR-2 level was 0.09 ng/mL in the HCA Group vs 0.1 ng/mL in non-HCA Group, and the median sTLR-4 level was 0.23 ng/mL in the HCA Group vs 0.28 ng/mL in non-HCA Group (p > 0.05). A positive correlation between sTLR-2 and sTLR-4 levels was identified (ρ = 0.57, p < 0.001), but no correlation was found between these markers and gestational age. CONCLUSIONS Concentrations of sTLR-2 and sTLR-4 in vaginally obtained amniotic fluid do not reflect the presence of HCA in pregnancies complicated by preterm premature rupture of membranes before 34 weeks of gestation.
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Affiliation(s)
- Greta Balciuniene
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Violeta Gulbiniene
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Greta Kvederaite-Budre
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Irena Dumalakiene
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Rita Viliene
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ingrida Pilypiene
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Grazina S Drasutiene
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Prognostic Markers for Chorioamnionitis: IL-6, TNF-α, and MMP-8 in Vaginally Obtained Amniotic Fluid. J Clin Med 2021; 10:jcm10051136. [PMID: 33800521 PMCID: PMC7962957 DOI: 10.3390/jcm10051136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background. Earlier chorioamnionitis diagnosis is crucial to improve maternal and neonatal health outcomes. This study was conducted to evaluate the inlerleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and matrix metalloproteinase 8 (MMP-8) levels in vaginally obtained amniotic fluid to investigate their prognostic value and to determine the most appropriate cut-off values for the prediction of chorioamnionitis. Methods. This case control study included women who were diagnosed with preterm premature rupture of the membranes before 34 weeks of gestation and were admitted to Vilnius University Hospital Santaros Klinikos. Free-leaking amniotic fluid was obtained vaginally with a sterile speculum less than 48h before delivery. Amniotic fluid IL-6, TNF-α, and MMP-8 levels were determined by the Enzyme Linked Immunosorbent Assay. Diagnosis of chorioamnionitis was confirmed by histological examination of the placenta and membranes after delivery. Results. The study included 156 women, 65 patients in the histological chorioamnionitis group (Group I) and 91 in a group without diagnosed histological chorioamnionitis (Group II). The median concentrations of IL-6, MMP-8, and TNF-α in amniotic fluid were statistically significantly higher in Group I than in Group II (p-value < 0.001). The area under the curve of TNF-α and MMP-8 were higher than the area under the curve of IL-6 (0.91, 0.89, and 0.81, respectively). No statistically significant difference was found when comparing the receiver operating characteristic (ROC) curves of TNF-α and MMP-8. The optimum cut-off values for the prediction of chorioamnionitis were found to be 1389.82 pg/mL for IL-6, 21.17 pg/mL for TNF-α, and 172.53 ng/mL for MMP-8. The sensitivity, specificity, positive prognostic value (PPV), and negative prognostic value (NPV) of the IL-6 cut-off for chorioamnionitis were 88%, 70%, 67%, and 89%, respectively. The sensitivity, specificity, PPV, and NPV of the TNF-α cut-off were 88%, 84%, 79%, and 90%, respectively. The sensitivity, specificity, PPV, and NPV of the MMP-8 cut-off were 80%, 87%, 81%, and 86%, respectively. Conclusions. The vaginally obtained amniotic fluid IL-6, MMP-8, and TNF-α seem to be good predictors for chorioamnionitis of patients with preterm premature rupture of membranes before 34 weeks of gestation. The noninvasive technique of sampling amniotic fluid could be alternative method to invasive amniocentesis.
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Zhu J, Ma C, Zhu L, Li J, Peng F, Huang L, Luan X. A role for the NLRC4 inflammasome in premature rupture of membrane. PLoS One 2020; 15:e0237847. [PMID: 32833985 PMCID: PMC7446792 DOI: 10.1371/journal.pone.0237847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
PROM is one of the common complications of perinatal period, which seriously threatens the mother and newborn. The purpose of this study was to identify the role of NLRC4 inflammasomes in this process and their underlying mechanisms. We performed high-throughput RNA sequencing of fetal membrane tissue from 3 normal pregnant women and 3 term-premature rupture of fetal membrane (TPROM) patients who met the inclusion criteria, and found that NLRC4 was significantly up-regulated in TPROM patients. An observational study of TPROM patients (PROM group, n = 30) and normal pregnant women (control group, n = 30) was performed at the Xuzhou Maternal and Child Health Hospital affiliated to Xuzhou Medical University from May 2018 to May 2019. The expression of genes involved in inflammasome complex including NLRC1, NLRC3, AIM2, NLRC4, ASC, caspase-1, IL-6, IL-18 and IL-1βwas determined via real-time PCR, immunohistochemistry and immunofluorescence. Measurement of NLRC4 level in serum was conducted by ELISA assay. The results showed that the NLRC4, ASC, caspase-1, IL-1β and IL-18 levels in fetal membrane, placental tissues and maternal serum were markedly higher in the PROM group than that in the control group. In conclusion, NLRC4 is a markedly up-regulated gene in TPROM fetal membrane tissue, suggesting that NLRC4 is involved in the occurrence and development of TPROM; NLRC4 levels in maternal blood serum are closely related to TPROM and have the potential to assist doctors in predicting and diagnosing PROM.
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Affiliation(s)
- Jinming Zhu
- Department of Obstetrics, Xuzhou Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
- * E-mail:
| | - Chunling Ma
- Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lina Zhu
- Department of Obstetrics and Gynecology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Juan Li
- Department of Obstetrics, Xuzhou Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fengyun Peng
- Department of Obstetrics, Xuzhou Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lei Huang
- Department of Obstetrics, Xuzhou Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaomei Luan
- Department of Obstetrics, Xuzhou Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
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