American Journal of Obstetrics and Gynecology
ResearchObstetricsAmniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes
Section snippets
Materials and Methods
This report involved a subset of subjects from a larger multicenter study, the goal of which was to develop a noninvasive test to screen for intraamniotic infection based on cervicovaginal proteins. The protocol was approved by the local institutional review board at each participating site.
Results
From September 2007 through November 2009, 338 women who met all the inclusion criteria were enrolled at 16 sites. Of these, 18 women withdrew or were lost to follow-up evaluation, and 15 were excluded because of inadequate specimens, which left 305 women for the analyses presented here. The number of women at each site and the gestational ages at amniocentesis are tabulated in Table 1.
Comment
Our results confirm previous observations that women in preterm labor have high rates of intraamniotic infection and inflammation, especially at early gestational ages.2, 3, 4 We also confirm that intraamniotic inflammation, which is evidenced by high IL-6 levels, is associated with short latency and high rates of perinatal morbidity and mortality whether or not microbes are detected in the amniotic fluid.3, 4
We present 4 novel findings: (1) In the inflammation groups, the absence of MIAC was
Conclusion
In preterm labor with intact membranes, there is a high rate of intraamniotic infection and inflammation, especially at early gestational ages. Latency and perinatal morbidity and death are related more closely to the degree of the inflammatory response than to the presence or absence of microbes in the amniotic fluid. Microbial colonization without inflammatory response may be relatively benign.
Acknowledgments
ProteoGenix/Obstetrix Collaborative Research Network
Investigative sites. Obstetrix Medical Group, Phoenix Perinatal Associates, Phoenix, AZ: William Clewell, MD; Banner Good Samaritan Medical Center, Phoenix, AZ: Melissa Ingersoll, RN, CRC; Banner Desert Samaritan Medical Center, Phoenix, AZ: Ana Braescu, RN, MS; Obstetrix Medical Group of Arizona, Tucson Medical Center, Tucson, AZ: Hugh Miller, MD and Diane Mercer, RN, CCRC; Obstetrix Medical Group of Colorado, Presbyterian Saint Luke's
References (76)
- et al.
Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes
Am J Obstet Gynecol
(2001) - et al.
Amniotic fluid infection, cytokines, and adverse outcome among infants at 34 weeks' gestation or less
Obstet Gynecol
(2001) - et al.
The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and Gram stain in patients with preterm labor and intact membranes
Am J Obstet Gynecol
(1993) - et al.
The value of amniotic fluid interleukin-6 determination in patients with preterm labor and intact membranes in the detection of microbial invasion of the amniotic cavity
Am J Obstet Gynecol
(1994) - et al.
Amniotic fluid interleukin-6: correlation with upper genital tract microbial colonization and gestational age in women delivered after spontaneous labor versus indicated delivery
Am J Obstet Gynecol
(1995) - et al.
Is amniotic fluid analysis the key to preterm labor? A model using interleukin-6 for predicting rapid delivery
Am J Obstet Gynecol
(1998) - et al.
Amniotic fluid matrix metalloproteinase-8 indicates intra-amniotic infection
Am J Obstet Gynecol
(2001) - et al.
Amniotic fluid matrix metalloproteinase-8 in preterm labor with intact membranes
Am J Obstet Gynecol
(2001) - et al.
The use of the polymerase chain reaction to detect bacteria in amniotic fluid in pregnancies complicated by preterm labor
Am J Obstet Gynecol
(1997) - et al.
Specific detection of 16 micro-organisms in amniotic fluid by polymerase chain reaction and its correlation with preterm delivery occurrence
Am J Obstet Gynecol
(1998)
Clinical implications of detection of Ureaplasma urealyticum in the amniotic cavity with the polymerase chain reaction
Am J Obstet Gynecol
The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor
Am J Obstet Gynecol
The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology
Am J Obstet Gynecol
Detection of bacteria in placental tissues obtained from extremely low gestational age neonates
Am J Obstet Gynecol
Colonization of second-trimester placenta parenchyma
Am J Obstet Gynecol
An experimental model for intraamniotic infection and preterm labor in Rhesus monkeys
Am J Obstet Gynecol
Immunomodulators plus antibiotics delay preterm delivery after experimental intraamniotic infection in a nonhuman primate model
Am J Obstet Gynecol
Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model
Am J Obstet Gynecol
Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes
Am J Obstet Gynecol
Possible association between amniotic fluid micro-organism infection and microflora in the mouth
BJOG
Widespread microbial invasion of the chorioamniotic membranes is a consequence and not a cause of intraamniotic infection
Lab Invest
The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor
Am J Obstet Gynecol
Mycoplasma hominis and Ureaplasma urealyticum in midtrimester amniotic fluid: association with amniotic fluid cytokine levels and pregnancy outcome
Am J Obstet Gynecol
Elevated second-trimester amniotic fluid interleukin-6 levels predict preterm delivery
Am J Obstet Gynecol
Amniotic fluid interleukin-6 and tumor necrosis factor-α at mid-trimester genetic amniocentesis: relationship to intra-amniotic microbial invasion and preterm delivery
Eur J Obstet Gynecol Reprod Biol
An elevated amniotic fluid matrix metalloproteinase-8 level at the time of mid-trimester genetic amniocentesis is a risk factor for spontaneous preterm delivery
Am J Obstet Gynecol
The fetal inflammatory response syndrome
Am J Obstet Gynecol
Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis
Am J Obstet Gynecol
Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial
Lancet
Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial
Lancet
Eradication of Ureaplasma urealyticum from the amniotic fluid with transplacental antibiotic treatment
Am J Obstet Gynecol
Eradication of intra-amniotic Streptococcus mutans in a woman with a short cervix
J Obstet Gynecol Can
Interleukin-10 administration and bacterial endotoxin-induced preterm birth in a rat model
Obstet Gynecol
Maternal infection-induced white matter injury is reduced by treatment with interleukin-10
Am J Obstet Gynecol
A rapid matrix metalloproteinase-8 bedside test for the detection of intraamniotic inflammation in women with preterm premature rupture of membranes
Am J Obstet Gynecol
Noninvasive diagnosis of intraamniotic infection: proteomic biomarkers in vaginal fluid
Am J Obstet Gynecol
The preterm parturition syndrome
BJOG
The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labor
Obstet Gynecol
Cited by (0)
Supported by a research grant from ProteoGenix, Inc; statistical analyses supported by Hologic, Inc.
Each author had grant support, consulting arrangements, employment, or equity interests with the sponsor, ProteoGenix, Inc. C.A.C. and T.J.G. have served on advisory boards; J.L. has a consulting arrangement, and J.K.B. has an unrelated research grant with Hologic, Inc, which acquired ProteoGenix in 2010.
Reprints not available from the authors.
Cite this article as: Combs CA, Gravett M, Garite TJ, et al. Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes. Am J Obstet Gynecol 2014;210:125.e1-15.