To compare the diagnostic value of soluble intercellular adhesion molecule 1 (sICAM-1) with that of c-reactive protein (CRP) for detecting chorioamnionitis (CAM) in serum of women with premature rupture of membranes (PROM), 55 pregnant women with PROM, including 18 pregnant women with preterm premature rupture of membranes (PPROM) and 20 normal pregnant women at term (TPROM) were studied. Maternal serum were measured by Sandwish enzyme-linked immunoabsorbent assay (ELISA) for sICAM. CAM was histologically confirmed after delivery. The results revealed that (1) maternal serum levels of sICAM-1 and CRP were significantly higher in women with PROM than those without it; (2) maternal serum levels of sICAM-1 and CRP were significantly higher in women with CAM than those without it; (3) serum levels of sICAM-1 in PPROM women were similar to those in TPROM women, whereas serum levels of CRP in PPROM women were significantly higher than those in TPROM women; (4) the sensitivity, specificity, positive predictive value, negative predictive value, Kappa index and area under receiver operating characteristic (ROC) curve of maternal serum sICAM-1 (cutoff 104.7 ng/ml) and CRP (cutoff 1.03 mg/dl) for diagnosing CAM were 100%, 91.2%, 87.5%, 100%, 0.20, 0.995 and 81.0%, 73.5%, 65.4%, 86.2%, 0.13, 0.811, respectively; (5) among the mild histological CAM group, severe histological CAM group and clinical CAM group, the difference in maternal serum levels of sICAM-1 were significantly (P<0.001), with the order of concentration from high level to low level corresponding to the severity of CAM. It is concluded that maternal serum level of ICAM-1 is superior to that of CRP as biomarker for diagnosing intraamniotic infection in pregnant women with PROM.
Biological Markers/blood ; Chorioamnionitis/*blood ; Chorioamnionitis/diagnosis ; Chorioamnionitis/etiology ; Fetal Membranes, Premature Rupture/*blood ; Intercellular Adhesion Molecule-1/*blood

PURPOSE: To evaluate the diagnostic performance of maternal inflammatory marker: C-reactive protein (CRP) in predicting early onset neonatal sepsis (that occurring within 72 hours after birth). MATERIALS AND METHODS: 126 low birth weight newborns (gestation 32+/-3.2 wk, birth weight 1887+/-623 g) and their mothers were included. Neonates were divided into sepsis group (n=51) including both proven (positive blood culture) and suspected (negative blood culture but with more than 3 abnormal clinical signs), and controls (n=75). Mothers were subgrouped into CRP positive > or =1.22 mg/dL (n=48) and CRP negative <1.22 mg/dL (n=78) group, determined by Receiver Operating Characteristic curves, and odds ratio was calculated for neonatal sepsis according to maternal condition. RESULTS: Maternal CRP was significantly higher in neonatal sepsis group than in control (3.55+/-2.69 vs. 0.48+/-0.31 mg/dL, p=0.0001). Maternal CRP (cutoff value >1.22 mg/dL) had sensitivity 71% and specificity 84% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group (71% vs. 29%, p<0.001). Odds ratio of neonatal sepsis in maternal CRP positive group versus CRP negative group was 10.68 (95% confidence interval: 4.313-26.428, p<0.001). CONCLUSION: The risk of early onset neonatal sepsis significantly increased in the case of positive maternal CRP (> or =1.22 mg/dL). In newborn of CRP positive mother, the clinician may be alerted to earlier evaluation for possible neonatal infection prior to development of sepsis.
C-Reactive Protein/*metabolism ; Chorioamnionitis/metabolism ; Female ; Humans ; Infant, Newborn ; Male ; Mothers ; Pregnancy ; Sepsis/diagnosis/*metabolism

OBJECTIVE: Acute inflammatory lesions in the placenta is one of the most common histopathologic lesions of women with preterm premature rupture of membrane. But there is a few scientific evidence to support the association between amniotic fluid white blood cell count and the presence and severity of acute placental inflammation in preterm premature rupture of membrane. To evaluate the relationship between amniotic fluid white blood cell count and the presence and severity of acute placental inflammatory lesions in preterm premature rupture of membrane. METHODS: The relationship between amniotic fluid white blood cell count and placental histologic finding was examined in 89 consecutive patients who were admitted with the diagnosis of preterm premature rupture of membrane and who delivered singleton gestation within 3 days. RESULTS: The prevalence of acute histologic chorioamnionitis was 68.5%(61/89) and that of positive amniotic fluid culture was 32.6%(29/89). The prevalence of positive amniotic fluid culture increased according to the higher severity of inflammation in each type of placental section(p<0.05 for each). The median amniotic fluid white blood cell count increased significantly according to the presence and higher severity of inflammation in each type of placental section(p<0.01 for each). The median amniotic fluid white blood cell count increased significantly according to the higher total grade of inflammation in placental histologic examination(p<0.01). CONCLUSION: Both the presence and higher severity of acute histologic chorioamnionitis are associated with an elevated amniotic fluid white blood cell count. The total grade of acute histologic chorioamnionitis is associated with an elevated amniotic fluid white blood cell count. Amniotic fluid white blood cell count is a reliable prenatal marker of histologic chorioamnionitis."
Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Female ; Humans ; Inflammation* ; Leukocyte Count* ; Leukocytes* ; Membranes* ; Placenta ; Pregnancy ; Prevalence ; Rupture*

OBJECTIVE: To evaluate the relationship between amniotic fluid interleukin-8 and the presence, severity and pattern of acute inflammatory lesions in the placenta delivered after preterm labor with intact membranes. METHODS: The relationship between placental histologic finding and amniotic fluid interleukin-8 was examined in 46 consecutive patients who were admitted with the diagnosis of preterm labor with intact membranes and who delivered singleton gestations within 5 days. RESULTS: The prevalence of acute histologic chorioamnionitis was 63.0%(29/46) and that of positive amniotic fluid culture was 17.4%(8/46). The most frequent site of histologic inflammation was chorion-decidua(56.5%, 26/46). The median amniotic fluid interleukin-8 increased significantly according to the presence and higher severity of inflammation in each type of placental section (p<0.05 for each). Three patterns of inflammation were identified in chorion-decidua: non-marginating, marginating, and mixed. Median amniotic fluid interleukin-8 and the rate of severe histologic chorioamnionitis (grade> or = 4) increased significantly in the order of non-marginating, marginating, and mixed (p<0.05 for each). CONCLUSION: Both the presence and greater severity of acute histologic chorioamnionitis are associated with an elevated amniotic fluid interleukin-8. A marginating and mixed pattern of inflammation are associated with a higher amniotic fluid interleukin-8. Amniotic fluid interleukin-8 is a reliable prenatal marker of histologic chorioamnionitis.
Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Female ; Humans ; Inflammation* ; Interleukin-8* ; Membranes ; Obstetric Labor, Premature* ; Placenta ; Pregnancy ; Prevalence

OBJECTIVE: Our purpose was to determine whether amniotic amniotic fluid concentrations of interleukin-6 are valuable in the prediction of histologic chorioamnionitis and in the prediction of perinatal morbidity. STUDY DESIGN: The relation among amniotic fluid imterleukin-6, histologic chorioamnionitis, and perinatal outcome was examined in patients with preterm labor and intact membranes. Interleukin-6 was determined by ELISA method. RESULTS: Patients with histologic chorioamnionitis had significantly higher amniotic fluld interleukin-6 concentrations than patient without histologic chrioamnionitis. Also, patient with histologic chorioamnioitis had significantly higher perinatal morbidity rate than patient without histologic chorioamnionitis. An ammiotic fluld interlerkin-6 concentration had a sensitivity of 75% and a specificity of 62.5% in the diagnosis of preterm delivery. CONCLUSION: Amniotic fluld interleukin-6 is a sensitive test for the prediction of histologic chorioamnionitis and of perinatal morbidity.
Amniotic Fluid* ; Chorioamnionitis* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-6* ; Membranes* ; Obstetric Labor, Premature* ; Pregnancy ; Sensitivity and Specificity

To compare the diagnostic value of soluble intercellular adhesion molecule 1 (sICAM-1) with that of c-reactive protein (CRP) for detecting chorioamnionitis (CAM) in serum of women with premature rupture of membranes (PROM), 55 pregnant women with PROM, including 18 pregnant women with preterm premature rupture of membranes (PPROM) and 20 normal pregnant women at term (TPROM) were studied. Maternal serum were measured by Sandwish enzyme-linked immunoabsorbent assay (ELISA) for sICAM. CAM was histologically confirmed after delivery. The results revealed that (1) maternal serum levels of sICAM-1 and CRP were significantly higher in women with PROM than those without it; (2) maternal serum levels of sICAM-1 and CRP were significantly higher in women with CAM than those without it; (3) serum levels of sICAM-1 in PPROM women were similar to those in TPROM women, whereas serum levels of CRP in PPROM women were significantly higher than those in TPROM women; (4) the sensitivity, specificity, positive predictive value, negative predictive value, Kappa index and area under receiver operating characteristic (ROC) curve of maternal serum sICAM-1 (cutoff 104.7 ng/ml) and CRP (cutoff 1.03 mg/dl) for diagnosing CAM were 100%, 91.2%, 87.5%, 100%, 0.20, 0.995 and 81.0%, 73.5%, 65.4%, 86.2%, 0.13, 0.811, respectively; (5) among the mild histological CAM group, severe histological CAM group and clinical CAM group, the difference in maternal serum levels of sICAM-1 were significantly (P<0.001), with the order of concentration from high level to low level corresponding to the severity of CAM. It is concluded that maternal serum level of ICAM-1 is superior to that of CRP as biomarker for diagnosing intraamniotic infection in pregnant women with PROM.
Biomarkers ; blood ; Chorioamnionitis ; blood ; diagnosis ; etiology ; Female ; Fetal Membranes, Premature Rupture ; blood ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; Pregnancy

OBJECTIVES: Our purpose was (1) to determine whether amniotic fluid concentrations of interleukin-6 are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of significant perinatal morbidity and mortality in patients with preterm premature rupture of membranes and (2) to compare the diagnostic performance of amniotic fluid interleukin-6 with that of amniotic fluid microbial culture for these outcome variables. METHOD: The relation among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid interleukin-6 concentrations were examined in 65 patients with preterm premature rupture of membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Interleukin-6 level was determined by enzyme-linked immunosorbent assay. Receiver-operator characteristic curve, Mann-Whitney U test, and Fisher's exact test were used for analysis. RESULTS: 1) Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than those without histologic chorioamnionitis (median 12.6 ng/ml, range 0.03 to 142.2 ng/ml vs median 0.5 ng/ml, range 0.03 to 16 ng/ml; P < 0.0001). 2) Amniotic fluid having interleukin-6 concentrations higher than 3.2 ng/ml had a sensitivity of 78% (35/45) and specificity of 95% (19/20) in the diagnosis of acute histologic chorioamnionitis and sensitivity of 74% (25/34) and specificity of 65% (20/31) in the prediction of significant neonatal morbidity and mortality. 3) These sensitivities were significantly higher than those of amniotic fluid culture, but there were no significant difference in specificities between amniotic fluid interleukin-6 and culture (histologic chorioamnionitis: 78% vs 51%, p<0.01; significant neonatal morbidity and mortality: 74% vs 47%, p<0.01, respectively). CONCLUSIONS: Test of amniotic fluid interleukin-6 is of value and more sensitive than amniotic fluid culture for the antenatal diagnosis of histologic chorioamnionitis and for the prediction of perinatal outcome in patients with preterm premature rupture of membranes.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Infant, Newborn ; Interleukin-6* ; Membranes* ; Mortality ; Placenta ; Pregnancy ; Prenatal Diagnosis* ; Rupture* ; Sensitivity and Specificity

Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. BPD is a chronic respiratory disease related to lung-injury during the primary course of critical lung disease such as respiratory distress syndrome or when abnormal development of the preterm lung occurs. Abnormal lung development not only results from primary lung injury in the first days after birth, but also secondary injury through abnormal repair resulting in arrested and abnormal alveolarization, fibrosis and pulmonary vascular dysgenesis. Chorioamnionitis is a risk factor that plays an important role in the development of BPD. Ureaplasma subspecies (spp.) are the most common isolated organisms from chorioamniotic tissue after premature births. Therefore Ureaplasma spp. appear to play an important role in the development of BPD, and treatment or prophylactic treatment of these infections or colonization may reduce the incidence, morbidity and mortality of BPD. Ureaplasma spp. infections are challenging not only to treat, but also to diagnosis in a timely manner. This review summarizes the current state of treatment and new developments in the treatment of Ureaplasma exposure in premature infants.
Azithromycin ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Colon ; Diagnosis ; Female ; Fibrosis ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Lung ; Lung Diseases ; Lung Injury ; Mortality ; Parturition ; Pregnancy ; Premature Birth ; Risk Factors ; Ultrasonography ; Ureaplasma*

BACKGROUND: Intrauterine infection has been recognized as a major etiologic factor for preterm labor and delivery. Moreover, an accumulating body of evidence suggests that intrauterine infection is associated with poor perinatal outcome. Several antenatal tests, including amniotic fluid tests, have been proposed to be useful in the identification of intrauterine infection and prediction of adverse perinatal outcome in patients with preterm labor and intact membranes. However, those tests require the performance of an invasive procedure, amniocentesis. Maternal blood C-reactive protein(CRP) has been studied extensively as a noninvasive test in the diagnosis of intrauterine infection. OBJECTIVE: 1) to determine the diagnostic performance of maternal bood CRP in identification of intrauterine infection and 2) to establish the prognostic value of maternal blood CRP as an antepartum test for neonatal morbidity, especially sepsis, in neonates born to mothers with preterm labor and intact membrances. STUDY DESIGN: Maternal blood samples for CRP tests were obtained at the time of admission in 91 patients with preterm labor and intact membranes. Serum CRP concentrations were measured by antibody adsorption-particle agglutination assay technique. Histologic examination of delivered placenta and follow-up for maternal and neonatal outcome were performed. Receiver-operator characteristic(ROC) curve, logistic regression, and survival analysis techniques were used for statistical analysis. RESULTS: Patients with acute histologic chorioamnionitis had significantly higher median maternal blood CRP concentration than did patients without this lesion. ROC curve and survival analysis demonstrated that an elevated CRP concentration was strongly associated with the likelihood of acute histologic chorioamnionitis, shorter admission-to-delivery interval, significant neonatal morbidity, and neonatal sepsis. Multiple logistic regression analysis indicated that maternal blood CRP was a significant independent predictor for the occurrence of neonatal morbidity and neonatal sepsis even after adjustment of other independent variables. CONCLUSION: The results of this study suggest that maternal blood CRP has a diagnostic and prognostic value in patients with preterm labor and intact membranes.
Agglutination ; Amniocentesis ; Amniotic Fluid ; C-Reactive Protein* ; Chorioamnionitis ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; Logistic Models ; Membranes* ; Mothers ; Obstetric Labor, Premature* ; Placenta ; Pregnancy ; ROC Curve ; Sepsis

Umbilical cord cyst is correlated with the fetal chromosomal defects or its structural abnormality; therefore, the follow-up evaluations on fetal growth, lesion size, and concomitant congenital malformation are essential. Thus, when a prenatal ultrasonogram suspects an umbilical cord cyst, karyotyping is strongly recommended to rule out any chromosomal abnormality. The pathologic findings of necrotizing funisitis are paraumbilical exudates due to inflammatory changes, the secondary calcification change of the exudates, thrombosis, and sometimes edema of the umbilical cord. Even though incidence of umbilical cord cyst is rare, it must be differentiated from a cord edema caused by necrotizing funisitis. We have encountered a patient with a suspicious umbilical cord cyst in the third trimester of her pregnancy but the postpartum diagnosis turned out to be an umbilical cord edema by necrotizing funisitis, so we investigated the case with brief comparison to other literature.
Chorioamnionitis* ; Chromosome Aberrations ; Diagnosis ; Edema* ; Exudates and Transudates ; Female ; Fetal Development ; Follow-Up Studies ; Humans ; Incidence ; Karyotyping ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Third ; Thrombosis ; Ultrasonography* ; Umbilical Cord*