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

No abstract available.
C-Reactive Protein* ; Chorioamnionitis* ; Female ; Humans ; Membranes* ; Pregnancy ; Rupture*

OBJECTIVE: This study was performed to evaluate the clinical utility of transabdominal prophylactic amnioinfusion on oligohydroamnios caused by preterm premature rupture of membrane(PPROM). METHODS: There were 59 singleton pregnant women with oligohydroamnios caused by PPROM who were treated by transabdominal amnioinfusion at the department of from March 1997 to December 1998. Nineteen pregnant women who underwent prophylactic amnioinfusion were designated as study group and 40 pregnant women who did not undergo prophylactic amnioinfusion were designated as control group. Clinical data were drawn from medical records, such as time interval from amnioinfusion to deliver, birth weight, incidence of variable deceleration, Apgar score at 1 minute, Apgar score at 5 minutes, and so on. Statistical analyses were performed by means of Student t test, Mann Whitney U-test, Fisher's exact test where appropriate. P value below 0.05 was considered significant. RESULTS: The median interval from amnioinfusion to delivery w as longer in study group than in control group (13.0 29.3 days vs. 5.0 13.0 days, p<0.05). The incidence of variable deceleration during labor in study group was 16% and that in control group was 43%(p<0.05). The incidence of Apgar score at 5 minutes below 7 was lower in study group than that in control group(39% vs. 43%, p<0.05). The incidence of respiratory distress syndrome was lower in study group than that in control group(16% vs. 83%, p=0.05) However, there were no significant difference in the incidence of respiratory distress syndrome between them who did not undergo dexamethasone treatment, in mode of delivery, birth weight, and incidence of chorioamnionitis between two groups. CONCLUSION: Transabdominal prophylactic amnioinfusion may have a positive role in the management of PPROM.
Apgar Score ; Birth Weight ; Chorioamnionitis ; Deceleration ; Dexamethasone ; Female ; Humans ; Incidence ; Medical Records ; Pregnancy ; Pregnant Women ; 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: The aim of our study was to compare the thickness and histopathologic changes in the fetal membrane between premature rupture of membranes (PROM) and intact membrane after delivery. METHODS: In a prospective study involving 31 patients who were divided into 4 groups such as <37 weeks without PROM, <37 weeks with PROM, >or=37 weeks without PROM, and >or=37 weeks with PROM, we measured the thickness of membrane and studied the histopathologic findings in vitro by light microscopy of histological sections. RESULTS: The membrane thickness of <37 weeks with PROM group was thinner (35.9 micrometer) than that (42.3 micrometer) of <37 weeks without PROM group, but there was no statistical significance. The membrane thickness of >or=37 weeks with PROM and >or=37 weeks without PROM were similar (25.6 micrometer, 26.0 micrometer). But the membrane thickness of >or=37 weeks with/without PROM was significantly thinner (25.8 micrometer) compared with that (38.9 micrometer) of <37 weeks with/without PROM. The histopathologic features of PROM positive group was amnionitis with neutrophilic infiltration, focally or diffusely necrotic change of amniotic membrane, separation of amniotic membrane and degeneration of chorionic villi. CONCLUSION: The thickness of fetal membrane between PROM group and intact membrane group was not different but the thickness of fetal membrane between <37 weeks and >or=37 weeks was statistically significant. The histopathologic change of PROM positive group was prominent as amnionitis. Further evaluation will be needed about the relationship between membrane thickness and PROM.
Amnion ; Chorioamnionitis ; Chorionic Villi ; Extraembryonic Membranes ; Female ; Humans ; Membranes* ; Microscopy ; Neutrophils ; Pregnancy ; Prospective Studies ; Rupture*

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*

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

Although liver diseases in pregnancy are rare, they can seriously affect mother and fetus. Although any type of liver disease can develop during pregnancy, it is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiologic changes of pregnancy can be confounding with the symptoms of liver diseases. It can not only complicate mother's life but also burden life of fetus to growth restriction. We describe an uncommon case of acute hepatitis with disseminated intravascular coagulation and clinical chorioamnionitis coincidentally in mid-trimester pregnancy. She experienced the development of acute hepatitis of unknown causes. She presented with fever, maternal tachycardia, and fetal tachycardia. We decided termination of pregnancy because of 16 weeks' gestation. After termination, she was managed about acute hepatitis. So we report our case with a brief reviews of the literature.
Chorioamnionitis ; Disseminated Intravascular Coagulation ; Female ; Fetus ; Fever ; Hepatitis* ; Humans ; Liver Diseases ; Mothers ; Pregnancy* ; Pregnant Women ; Tachycardia

OBJECTIVE: There is no data on which is more important for the intensity of intra-amniotic inflammation (IAI) between total grade or involved anatomical region in acute histologic chorioamnionitis (acute-HCA) of preterm-gestations. The objective of current study is to examine this issue. METHODS: The intensity of IAI was measured by amniotic fluid (AF) white blood cell (WBC) count and matrix metalloproteinase-8 (MMP-8) concentration in 225 singleton preterm-gestations (<36 weeks) who had acute-HCA including chorio-decidua involvement and delivered within 5 days of amniocentesis. Acute-HCA was defined in the presence of acute inflammatory changes in each anatomical region (i.e., chorio-decidua, amnion or chorionic plate). Patients were divided into 6 groups according to total grade (i.e., 1-6) and the presence or absence of chorio-decidua restriction (i.e., chorio-decidua restriction vs. extension beyond chorio-decidua) of acute-HCA. RESULTS: There was no significant difference in a median AF WBC and MMP-8 between the two groups (group-1, cases with total grade 1 vs. group-2, cases with total grade 2) among cases with chorio-decidua restriction (each for P>0.05) and between the four groups (group-3, cases with total grade 2 vs. group-4, cases with total grade 3 vs. group-5, cases with total grade 4 vs. group-6, cases with total grade 5-6) among cases with extension beyond chorio-decidua (each for P>0.05). However, group-3 (cases with extension beyond chorio-decidua) had a significantly higher median AF WBC and MMP-8 than group-2 (cases with chorio-decidua restriction) among cases with total grade 2 (each for P<0.05). CONCLUSION: Involved anatomical region is more important than total grade for the intensity of IAI in acute-HCA of preterm-gestations.
Amniocentesis ; Amnion ; Amniotic Fluid ; Chorioamnionitis ; Chorion ; Female ; Humans ; Inflammation ; Leukocytes ; Matrix Metalloproteinase 8 ; Pregnancy

PURPOSE: The objective of this study is to determine the change of C-reactive protein (CRP) levels in the peripheral blood of preterm infants at birth according to the stage of intrauterine inflammation. METHODS: A total of 187 infants (<32 weeks of gestation) were divided into a "no histologic chorioamnionitis" [HCAM (-), n=85] group and a "histologic chorioamnionitis" [HCAM (+), n=102] group according to placental pathologic findings. Furthermore, the HCAM (+) group was subdivided into a "funisitis" [F (+), n=49] group and a "no funisitis" [F (-), n=53] group and also into a "funisitis/amnionitis" [FA (+), n=58] group and an "isolated chorio-deciduitis" [FA (-), n=44] group. High-sensitivity CRP levels in the peripheral blood at birth were measured. RESULTS: Peripheral blood CRP levels were significantly higher in the HCAM (+), F (+), F (-), and FA (+) groups than in the HCAM (-) group, but were not significantly different between the FA (-) and HCAM (-) groups. In addition, peripheral blood CRP levels were significantly higher in the F (+) and FA (+) groups than in the F (-) and FA (-) groups, respectively. For identification of amnionitis or funisitis, a cut-off value of 0.02 mg/dL was chosen. Clinical chorioamnionitis, proven early onset sepsis, histologic chorioamnionitis, and funisitis had higher incidences in infants with peripheral blood CRP levels higher than 0.02 mg/dL. CONCLUSION: The present study shows that peripheral blood CRP levels at birth in preterm infants born before 32 weeks' gestation is significantly increased in amnionitis or funisitis and might reflect the progress of histologic chorioamnionitis.
Amnion ; C-Reactive Protein ; Chorioamnionitis ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Parturition ; Pregnancy ; Sepsis