calca-protein--human and Fetal-Membranes--Premature-Rupture

Premature rupture of membranes is a common situation in obstetrics that links the amniotic cavity and the bacterial cervicovaginal flora. The main risk in case of preterm premature rupture of membranes is the occurrence of an amniochorial infection, which increases neonatal morbidity and mortality. One main purpose in cases of preterm premature rupture of membranes is to identify infection early to adapt the clinical care. Among the marker used in practice, CRP has a sensitivity between 56% and 86% and specificity between 55% and 82% for predicting clinical chorioamnionitis. These values are respectively 21% to 56% and 76% to 95% for the prediction of early neonatal infection. The white blood cell count, also used in routine, has a poor predictive value of clinical chorioamnionitis although a high specificity when the threshold is of 16 giga/l. Among the pro-inflammatory cytokines, interleukin-6 has been the most studied. Its predictive value for chorioamnionitis or neonatal infection is higher but its clinical usefulness is limited by the various threshold used in the studies and the lack of routine measure. Procalcitonin appears to have low predictive values for detecting amniochorial infection but has finally been little studied. Ways to improve prediction of infection in cases of premature rupture of membranes are either looking for new markers or the analysis of local markers (vaginal secretions and amniotic fluid).

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Interleukin-6; Leukocyte Count; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Protein Precursors; Sensitivity and Specificity; Vagina

The arsenal of maternal and amniotic fluid (AF) immune response to local or systemic infection includes among others the acute-phase reactants IL-6, C-Reactive Protein (CRP) and Procalcitonin (PCT). If these molecules can be used as non-invasive biomarkers of intra-amniotic infection (IAI) in the subclinical phase of the disease remains incompletely known.. We used time-matched maternal serum, urine and AF from 100 pregnant women who had an amniocentesis to rule out IAI in the setting of preterm labor, PPROM or systemic inflammatory response (SIR: pyelonephritis, appendicitis, pneumonia) to infection. Cord blood was analyzed in a subgroup of cases. We used sensitive immunoassays to quantify the levels of inflammatory markers in the maternal blood, urine and AF compartment. Microbiological testing and placental pathology was used to establish infection and histological chorioamnionitis.. PCT was not a useful biomarker of IAI in any of the studied compartments. Maternal blood IL-6 and CRP levels were elevated in women with subclinical IAI. Compared to clinically manifest chorioamnionitis group, women with SIR have higher maternal blood IL-6 levels rendering some marginal diagnostic benefit for this condition. Urine was not a useful biological sample for assessment of IAI using either of these three inflammatory biomarkers.. In women with subclinical IAI, the large overlapping confidence intervals and different cut-offs for the maternal blood levels of IL-6, CRP and PCT likely make interpretation of their absolute values difficult for clinical decision-making.

Topics: Adult; Amniocentesis; Amniotic Fluid; Asymptomatic Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chorioamnionitis; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Interleukin-6; Obstetric Labor, Premature; Placenta; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Protein Precursors; Systemic Inflammatory Response Syndrome

To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra-amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women.. The mean plasma ProCT levels of 32 patients with PPROM, 35 patients with PROM at term, 24 healthy women at preterm gestation and 30 healthy women at term were compared. In the PPROM group, the presence or absence of histological chorioamnionitis and neonatal infection were used as a reference to analyze ProCT levels.. The mean ProCT level of patients in the PPROM group was significantly higher than those in the PROM group and healthy controls. Patients in the PPROM group diagnosed with histological chorioamnionitis had significantly higher ProCT levels than those of the remaining patients. At a cut-off of 0.054 ng/mL, the sensitivity and specificity of ProCT to predict histological chorioamnionitis were 92.3% and 68.4%, respectively.. ProCT levels were significantly higher in patients with PPROM, and facilitate identification of those who require expectant management.

Topics: Adult; Amniotic Fluid; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chorioamnionitis; Early Diagnosis; Female; Fetal Membranes, Premature Rupture; Humans; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Protein Precursors; Up-Regulation; Young Adult

To compare vaginal fluid procalcitonin (PCT) concentrations in cases of preterm premature rupture of membranes (PPROM) and healthy pregnant women, and to determine whether the PCT concentrations are of value in the diagnosis of PPROM cases and clinical amnionitis.. 50 cases with PPROM and 50 healthy pregnant women were enrolled in the study. In the PPROM group, analysis was conducted on PCT concentrations with reference to serum leucocytosis, serum C-reactive protein level and urine analysis, as well as to presence/absence of clinical amnionitis. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA).. Procalcitonin levels in the PPROM group were significantly higher than in cases of healthy pregnant women (1.17 vs 0.05 ng/ml; p < 0.001). In the PPROM group PCT concentrations between the patients with and without clinical amnionitis were comparable. Also, a significant correlation was observed between PCT and leucocytosis (r = 0.64; p < 0.001) and C-reactive protein (r = 0.90; p < 0.001).. These findings suggest that the value of vaginal fluid PCT determinations can be useful for diagnostics of PPROM cases suspected of intrauterine infection.

Topics: Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cervix Uteri; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Leukocytosis; Pregnancy; Protein Precursors; Vagina

Our objective is to compare maternal plasma procalcitonin concentrations in preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term with their levels in uncomplicated pregnancy, and to determine whether these concentrations are useful in the diagnosis of pPROM cases suspected of infection and in the prediction of pPROM-to-delivery interval.. Forty eight patients with pPROM, 30 with PROM at term, 31 healthy women at preterm gestation, and 33 healthy women at term were included. In pPROM group, analysis of procalcitonin concentrations with reference to leucocytosis, serum C-reactive protein, vaginal fluid culture, neonatal infection, histological chorioamnionitis and pPROM-to-delivery interval was carried out.. Procalcitonin concentrations in pPROM and PROM at term cases were comparable. However, in both groups procalcitonin values were significantly higher than in healthy controls in approximate gestational age. In pPROM group, procalcitonin concentrations between the patients with and without laboratory indices of infection were comparable, as well as between patients who gave birth to newborns with and without congenital infection, and between patients with and without histological chorioamnionitis. The predictive values of procalcitonin determinations were poor.. The value of maternal plasma procalcitonin determinations in the diagnostics of pPROM cases suspected of intraamniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, procalcitonin concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnants, and therefore further evaluations are necessary to establish the role of procalcitonin in the pathophysiology of pregnancy.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Obstetric Labor, Premature; Pregnancy; Protein Precursors

To compare procalcitonin (PCT) concentrations between maternal blood and levels in umbilical cord or venous blood of neonates who were born with or without infection.. Forty-six women with singleton pregnancies, complicated by premature rupture of membranes, preterm delivery and/or chorioamnionitis, were enrolled in this study. The study group comprised 15 patients and their infected newborns. The control group consisted of 31 women and their healthy newborns. We compared PCT concentrations between maternal, umbilical cord and neonatal serum, in both study and control groups. Additionally, PCT levels were compared between the corresponding compartments.. PCT concentrations in the umbilical cord and venous blood in infected newborns, but not in non-infected neonates, were significantly higher than maternal serum PCT levels. PCT concentrations of mothers who delivered infected newborns were comparable to those in the controls. However, PCT concentrations in the umbilical cord and in the venous blood of the infected newborns were higher than in healthy newborns.. Measurement of maternal PCT concentration during labor does not contribute to early prediction of infection in the neonate. However, umbilical cord PCT concentrations, as well as its neonatal venous levels on the second day of life, seem to be related to intrauterine infection, and may be a useful tool in the diagnosis of early neonatal infection.

Topics: Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chorioamnionitis; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Premature Birth; Protein Precursors

To compare vaginal fluid procalcitonin concentrations in cases of preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term, and to determine whether the procalcitonin concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval.. Forty-eight patients with pPROM and 30 with PROM at term were enrolled in this study. In pPROM group, analysis was conducted of procalcitonin concentrations with reference to serum leucocytosis, serum C-reactive protein levels and vaginal fluid culture, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval.. Procalcitonin levels in the pPROM group were significantly higher than in cases of amniorrhexis at term (1.50 vs 0.83 ng/mL; P < 0.001). In the pPROM group procalcitonin concentrations between the patients with and without positive laboratory indices of infection were comparable. Also, no significant correlation was observed between procalcitonin and leucocytosis (r = -0.14; P = 0.33) or C-reactive protein (r = -0.17; P = 0.24). Procalcitonin concentrations of patients who gave birth to newborns with infection were comparable to those in women whose newborns were healthy. In patients with histological chorioamnionitis, procalcitonin concentrations were comparable to those without inflammatory changes.. These findings suggest that the value of vaginal fluid procalcitonin determinations is unsatisfactory in the diagnostics of pPROM cases suspected of subclinical intrauterine infection, as well as for the prediction of pPROM-to-delivery interval, newborn's congenital infection or histological chorioamnionitis.

Topics: Adult; Body Fluids; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Leukocyte Count; Obstetric Labor, Premature; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Infectious; Protein Precursors; Sensitivity and Specificity; Vagina