The objective of this review is to evaluate the safety and effectiveness of the amniopatch procedure for the treatment ofpreterm premature rupture of the membranes. The searches were conducted via electronic databases including Ovid-MEDLINE, Ovid-Embase, the Cochrane Library, and eight Korean databases. In the study design, in addition to randomized controlled trials, case report studies in which patients underwent the amniopatch procedure were included. Two reviewers independently selected data in standardized form and assessed the methodological quality. Quality evaluation was performed by the SIGN (Scottish Intercollegiate Guideline Network) method. A total of 11 studies (2 cohort studies, 1 case series, and 8 case reports) were included. There were no serious maternal or fetal complications. It was reported that there were lower rates of maternal chorioamnionitis after the amniopatch relative to conservative treatment (control). The mean gestational age at delivery was 27.7 weeks (a total of 70 cases in 10 studies; spontaneous group, 27.6 weeks; iatrogenic group, 27.8 weeks). The amniopatch was successful in 46.6% of cases (33/71 cases in 11 studies). The overall neonatal survival rate was 55.3% (52/94 cases in 11 studies). Neonatal morbidity was 23.4% (11/47 cases in 7 studies). Although this systematic review, did not find clear evidence of the safety and effectiveness, the amniopatch procedure is a viable treatment option to prolong a pregnancy with previable premature rupture of membranes.
Blood Platelets ; Chorioamnionitis ; Cohort Studies ; Female ; Gestational Age ; Humans ; Membranes ; Pregnancy ; Rupture ; Survival Rate

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 including AF test results (e.g., AF IL-6 levels) in model 1, serum CRP concentrations were found to be insignificant, and thus, were excluded from 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 gestational age) was moderately predictive of histologic chorioamnionitis. The inclusion of invasive test results added no predictive information to the model in this setting.
Adult ; *Amniocentesis ; Amniotic Fluid/*cytology/microbiology ; C-Reactive Protein/*metabolism ; Chorioamnionitis/blood/*diagnosis/metabolism ; Cohort Studies ; Female ; Fetal Membranes, Premature Rupture/*blood ; *Gestational Age ; Humans ; Infant, Newborn ; Interleukin-6/blood ; Leukocyte Count ; Predictive Value of Tests ; Pregnancy ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo explore the relationship between histological chorioamnionitis (HCA) and fetal inflammatory response syndrome (FIRS) and brain injury in preterm infants.

METHODSOne hundred and three singleton infants with premature rupture of membranes (PROM) (gestation ages of less than 34 weeks) were enrolled. All the placentas were submitted for pathological evaluation. Umbilical cord blood interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-α) and granulocyte-colony stimulating factor (G-CSF) levels were measured with liquid chip. All preterm infants accepted brain imaging examinations. Based on the placental pathological examination and umbilical cord blood level of IL-6, the 103 infants were classified into HCA⁻ FIRS⁻, HCA⁺ FIRS⁻, and HCA⁺ FIRS⁺ groups.

RESULTSThe incidences of HCA, FIRS, and brain injury were 53.4%, 20.4% and 38.8% respectively. The prevalence of brain injury in HCA⁻ FIRS⁻, HCA⁺ FIRS⁻, and HCA⁺ FIRS⁺ cases was 21%, 41%, and 76% respectively (P<0.01). The grade 2 and grade 3 of placental inflammation and the inflammation at stage 2 and stage 3 increased the risk of brain injury. The cord blood levels of IL-8, TNF-α, and G-CSF in the HCA⁺ FIRS⁺ group were significantly higher than in the other two groups, and the levels of the above parameters in the HCA⁺ FIRS⁻ were higher than in the HCA⁻ FIRS⁻ group (P<0.05).

CONCLUSIONSPlacental inflammation and FIRS are associated with brain injury in preterm infants. Preterm infants exposed to severe placental inflammation have an increased risk of brain injury. Cord blood IL-8, TNF-α and G-CSF may be involved in the process of brain injury in preterm infants with placental inflammation and FIRS.

Brain Injuries ; etiology ; Chorioamnionitis ; pathology ; Female ; Granulocyte Colony-Stimulating Factor ; blood ; Humans ; Infant, Newborn ; Infant, Premature ; Inflammation ; complications ; Interleukin-8 ; blood ; Male ; Placenta ; pathology ; Pregnancy ; Tumor Necrosis Factor-alpha ; blood

PURPOSE: Intrauterine inflammation (IUI) is a leading cause of preterm delivery. Although matrix metalloproteinase-8 (MMP-8) and intercellular adhesion molecule-1 (ICAM-1) are known to be related with IUI, it has not been fully elucidated whether MMP-9 or ICAM-3 is associated with IUI. We performed this study to determine whether the levels of tumor necrosis factor-alpha (TNF-alpha), MMP-9 and ICAM-3 in umbilical cord blood of preterm infants are associated with chorioamnionitis, funisitis or bronchopulmonary dysplasia. METHODS: Eighty-two pairs of pregnant women and their preterm newborns <35 weeks gestation were enrolled. Levels of TNF-alpha, MMP-9 and ICAM-3 in umbilical cord blood were measured using immunoassays and compared with results of histological examination of placenta and clinical data of the study participants. RESULTS: The level of MMP-9 in umbilical cord blood was significantly associated with the presence of funisitis (P =0.007). The level of TNF-alpha in umbilical cord blood was significantly associated with the development of bronchopulmonary dysplasia (P =0.030). However, presence of chorioamnionitis or funisitis was not associated with development of bronchopulmonary dysplasia. With the establishment of receiver operating characteristic (ROC) curve, the best cut-off value for umbilical blood MMP-9 was 99.42 pg/mL in identification of funisitis. The area under a constructed ROC curve for prediction of funisitis was 0.847 (standard error, 0.112; 95% confidence interval, 0.750-0.917). CONCLUSION: Measurement of MMP-9 concentration in umbilical cord blood may be an alternative way to predict whether a preterm infant has been exposed to IUI. Further study with larger numbers of subjects will be necessary to elucidate the association between the presence of IUI and neonatal adverse outcome.
Bronchopulmonary Dysplasia ; Chorioamnionitis* ; Female ; Fetal Blood* ; Humans ; Immunoassay ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intercellular Adhesion Molecule-1 ; Matrix Metalloproteinase 8 ; Matrix Metalloproteinase 9* ; Placenta ; Pregnancy ; Pregnant Women ; ROC Curve ; Tumor Necrosis Factor-alpha

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (> or = 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.
Adult ; Age of Onset ; Area Under Curve ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Chorioamnionitis/blood/*diagnosis ; Cohort Studies ; Female ; Fetal Membranes, Premature Rupture/blood ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/blood/*diagnosis ; *Predictive Value of Tests ; Pregnancy ; Premature Birth/blood ; ROC Curve ; Retrospective Studies ; Sepsis/blood/*diagnosis

OBJECTIVETo evaluate the clinical significance of umbilical activin A in preterm infants.

METHODSForty-one preterm infants (gestation 28 to 36 weeks) were enrolled. Fetal membranes, umbilical cords and blood samples from umbilical vein were obtained. Umbilical activin A level was measured using ELISA. The histological examinations of fetal membranes and umbilical cords were performed.

RESULTSThe umbilical level of activin A averaged 2069 pg/mL in the 41 preterm infants. The umbilical activin A level in the 5 infants with intrauterine infection was higher than in those without intrauterine infection (2510 pg/mL vs 1975 pg/mL; P<0.01). Umbilical activin A level at cutoff of 2490 pg/mL showed a sensitivity of 80.0% and a specificity of 90.6% as a marker of intrauterine infection. There were no significant differences in the umbilical activin A level between the infants with and without respiratory distress syndrome. Umbilical activin A level was positively correlated with the duration of postnatal oxygen therapy (r=0.326, P<0.05).

CONCLUSIONSUmbilical activin A may serve a marker of intrauterine infection in preterm infants. The umbilical activin A level is correlated with the duration of postnatal oxygen therapy.

Activins ; blood ; Chorioamnionitis ; blood ; Enzyme-Linked Immunosorbent Assay ; Female ; Fetal Blood ; chemistry ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Male ; Pregnancy ; Pregnancy Complications, Infectious ; blood

Adult ; Biomarkers ; blood ; Chorioamnionitis ; diagnosis ; etiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Fetal Membranes, Premature Rupture ; blood ; Humans ; Interleukin-6 ; blood ; Matrix Metalloproteinase 9 ; blood ; Pregnancy

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

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

OBJECTIVE: The purpose of this study was to determine whether funisitis is associated with changes in the umbilical cord plasma concentration of interleukin-6 (IL-6) and matrix metalloproteinase-8 (MMP-8), microbial invasion of the amniotic cavity and neonatal outcome. METHODS: The relationship among the presence of funisitis, IL-6 and MMP-8 concentrations in umbilical cord plasma at birth, the results of amniotic fluid culture performed within 5 days of birth was examined in 83 consecutive singleton births (20-35 weeks' gestation). Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel wall or Wharton's jelly. The IL-6 and MMP-8 concentration was measured with a specific immunoassay. Amniocentesis was performed in 47 patients within 5 days of birth. RESULTS: (1) Funisitis was present in 21.7% of patients. (2) Patients with funisitis had a significant higher cord plasma IL-6 concentration, but had no significant difference in cord plasma MMP-8 concentration. (3) Clinical chorioamnionitis was more common in patients with funisitis than those without funisitis. (4) A cord plasma IL-6 > 6.34 pg/ml had a sensitivity of 77.8% and a specificity of 75.4% in the identification of funisitis. (5) No correlation between cord blood plasma IL-6 concentration and MMP-8 concentration was found. (6) There was no significant correlation between gestational age at birth and cord blood plasma MMP-8 concentrations, but there appeared to be a trend to increase of cord plasma MMP-8 concentrations as gestational ages at birth were increased. (7) Neonates with congenital sepsis had a significantly higher cord plasma IL-6 and MMP-8 concentration than those without congenital sepsis. CONCLUSION: In patient with funisitis, umbilical cord plasma IL-6 concentrations were higher than those without funisitis, but umbilical cord plasma MMP-8 concentrations had no significant difference in each group. The umbilical cord plasma IL-6 and MMP-8 can be useful as a predictor of the occurrence of congenital sepsis in preterm infant.
Amniocentesis ; Amniotic Fluid* ; Chorioamnionitis* ; Female ; Fetal Blood ; Gestational Age ; Humans ; Immunoassay ; Infant, Newborn ; Infant, Premature ; Interleukin-6* ; Matrix Metalloproteinase 8* ; Neutrophil Infiltration ; Parturition ; Plasma* ; Pregnancy ; Sensitivity and Specificity ; Sepsis ; Umbilical Cord* ; Wharton Jelly