The frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes |
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| Authors: | Kyung Joon Oh Roberto Romero Bo Hyun Yoon |
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| Institution: | 1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea;2. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, South Korea;3. Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA;4. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA;5. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA;6. Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA |
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| Abstract: | Objective: The objective of this study is to evaluate the frequency and clinical significance of intra-amniotic inflammation in twin pregnancies with preterm labor and intact membranes.Study design: Amniotic fluid (AF) was retrieved from both sacs in 90 twin gestations with preterm labor and intact membranes (gestational age between 20 and 34 6/7 weeks). Preterm labor was defined as the presence of painful regular uterine contractions, with a frequency of at least 2 every 10?min, requiring hospitalization. Fluid was cultured and assayed for matrix metalloproteinase-8. Intra-amniotic inflammation was defined as an AF matrix metalloproteinase-8 concentration >23?ng/mL.Results: The prevalence of intra-amniotic inflammation for at least 1 amniotic sac was 39% (35/90), while that of proven intra-amniotic infection for at least one amniotic sac was 10% (9/90). Intra-amniotic inflammation without proven microbial invasion of the amniotic cavity was found in 29% (26/90) of the cases. Intra-amniotic inflammation was present in both amniotic sacs for 22 cases, in the presenting amniotic sac for 12 cases, and in the non-presenting amniotic sac for one case. Women with intra-amniotic inflammation observed in at least one amniotic sac and a negative AF culture for microorganisms had a significantly higher rate of adverse pregnancy outcome than those with a negative AF culture and without intra-amniotic inflammation (lower gestational age at birth, shorter amniocentesis-to-delivery interval, and significant neonatal morbidity). Importantly, there was no significant difference in pregnancy outcome between women with intra-amniotic inflammation and a negative AF culture and those with a positive AF culture.Conclusion: Intra-amniotic inflammation is present in 39% of twin pregnancies with preterm labor and intact membranes and is a risk factor for impending preterm delivery and adverse outcome, regardless of the presence or absence of bacteria detected using cultivation techniques. |
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| Keywords: | Intra-amniotic infection intra-amniotic inflammation matrix metalloproteinase-8 preterm labor twin pregnancy |
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