Non-Invasive Prediction of Histologic Chorioamnionitis in Women with Preterm Premature Rupture of Membranes
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model. Materials and Methods: This retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis. Results: Risk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When includingAF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excludedfrom model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2. Conclusion: For women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestationalage) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.
Abstract
Purpose: To develop a model based on non-invasive clinical and ultrasonographic parameters for predicting the likelihood of subsequent histologic chorioamnionitis in women with preterm premature rupture of membranes (PPROM) and to determine whether the inclusion of invasive test results improves the predictive value of the model. Materials and Methods: This retrospective cohort study included 146 consecutive women presenting with PPROM (20–33 weeks). Transvaginal ultrasonographic assessment of cervical length was performed. Maternal serum C-reactive protein (CRP) levels and white blood cell (WBC) counts were measured after amniocentesis. Amniotic fluid (AF) obtained by amniocentesis was cultured, and interleukin-6 (IL-6) levels and WBC counts were determined. The primary outcome measure was histologic chorioamnionitis. Results: Risk scores based on serum CRP concentrations and gestational age (model 1) were calculated for each patient. The model was shown to have adequate goodness of fit and an area under the receiver operating characteristic curve (AUC) of 0.742. When includingAF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excludedfrom model 2, comprising AF IL-6 levels and gestational age. No significant difference in AUC was found between models 1 and 2. Conclusion: For women with PPROM, the newly developed model incorporating non-invasive parameters (serum CRP and gestationalage) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.
참고문헌 (30)
- Cobo T, "A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes:analyses of multiple proteins in the amniotic fluid", J Matern Fetal Neonatal Med, 25, pp.1995~2001 (2012)
- Park KH, "Noninvasive prediction of intra-amniotic infection and", or inflammation in preterm premature rupture of membranes, 2012, pp.19, 658~665
- Elimian A, "Histologic chorioamnionitis, antenatal steroids, and perinatal outcomes", Obstet Gynecol, 96, pp.333~336 (2000)
- Yoon BH, "Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity", Am J Obstet Gynecol, 172, pp.960~970 (1995)
- Oh KJ, "Predictive value of intra-amniotic and serum markers for inflammatory lesions of preterm placenta", Placenta, 32, pp.732~736 (2011)
- Jacobsson B, "Infectious and inflammatory mechanisms in preterm birth and cerebral palsy", Eur J Obstet Gynecol Reprod Biol, 115, pp.159~160 (2004)
- van de Laar R, "Accuracy of C-reactive protein determination in predicting chorioamnionitis and neonatal infection in pregnant women with premature rupture of membranes: a systematic review", Eur J Obstet Gynecol Reprod Biol, 147, pp.124~129 (2009)
- Yoon BH, "Serum Creactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes", Obstet Gynecol, 88, pp.1034~1040 (1996)
- Gonçalves LF, "Intrauterine infection and prematurity", Ment Retard Dev Disabil Res Rev, 8, pp.3~13 (2002)
- Park KH, "Prediction of imminent preterm delivery in women with preterm premature rupture of membranes", J Perinat Med, 40, pp.151~157 (2011)
- 이성윤, "Intra-Amniotic Infection", Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor, 2013, pp.28(8), 1226~1232[DOI]
- 박교훈, "Transvaginal Ultrasonographic Cervical Measurement in PredictingFailed Labor Induction and Cesarean Delivery for Failure to Progressin Nulliparous Women", Journal of Korean Medical Science, 22(4), pp.722~727 (2007), 대한의학회
- Gibbs RS, "Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term", J Infect Dis, 145, pp.1~8 (1982)
- Jobe AH, "Bronchopulmonary dysplasia", Am J Respir Crit Care Med, 163, pp.1723~1729 (2001)
- Dulay AT, "Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis", Am J Obstet Gynecol, 198, pp.426.e1~421.e1 (2008)
- Yoon BH, "Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1beta, and tumor necrosis factor-alpha), neonatal brain white matter lesions, and cerebral palsy", Am J Obstet Gynecol, 177, pp.19~26 (1997)
- Richter D, "Prevention of necrotizing enterocolitis in extremely low birth weight infants by IgG feeding?", Eur J Pediatr, 157, pp.924~925 (1998)
- Perkins NJ, "The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve", Am J Epidemiol, 163, pp.670~675 (2006)
- Hanley JA, "A method of comparing the areas under receiver operating characteristic curves derived from the same cases", Radiology, 148, pp.839~843 (1983)
- Jun JK, "Interleu-kin 6 determinations in cervical fluid have diagnostic and prognostic value in preterm premature rupture of membranes", Am J Obstet Gynecol, 183, pp.868~873 (2000)
- Fisk NM, "Is C-reactive protein really useful in preterm premature rupture of the membranes?", Br J Obstet Gynaecol, 94, pp.1159~1164 (1987)
- Rizzo G, "Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes", Ultrasound Obstet Gynecol, 12, pp.86~92 (1998)
- Hillier SL, "The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection", Obstet Gynecol, 81, pp.941~948 (1993)
- Gire C, "Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes", Ultrasound Obstet Gynecol, 19, pp.565~569 (2002)
- Ghidini A, "Lack of relationship between histologic chorioamnionitis and duration of the latency period in preterm rupture of membranes", J Matern Fetal Med, 7, pp.238~242 (1998)
- Ovalle A, "Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study", J Matern Fetal Neonatal Med, 12, pp.35~41 (2002)
- Hutzal CE, "Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis", Am J Obstet Gynecol, 199, pp.620.e1~628.e1 (2008)
- Ohlsson A, "An analysis of antenatal tests to detect infection in preterm premature rupture of the membranes", Am J Obstet Gynecol, 162, pp.809~818 (1990)
- Ramsey PS, "Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes", Am J Obstet Gynecol, 192, pp.1162~1166 (2005)
- Royston P, "Dichotomizing continuous predictors in multiple regression: a bad idea", Stat Med, 25, pp.127~141 (2006)