OBJECTIVE: This study evaluated maternal C-reactive protein (CRP) as a predictor of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with preterm prelabor rupture of the membranes (PPROM) before and after 32 weeks of gestation. METHODS: This study was a prospective observational cohort study of 386 women. Maternal serum CRP concentrations were evaluated, and amniotic fluid samples were obtained via transabdominal amniocentesis at the time of admission. Placentas underwent histopathological examination after delivery. MIAC was defined based on a positive PCR for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive 16S rRNA gene amplification. HCA was defined based on the Salafia classification. RESULTS: Maternal CRP was significantly higher in women with MIAC and HCA (median 9.0 mg/l) than in women with HCA alone (median 6.9 mg/l), MIAC alone (median 7.4 mg/l) and without MIAC or HCA (median 4.5 mg/l) (p<0.0001). CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation. Only the 95th percentile of CRP and PPROM before 32 weeks exhibited a false-positive rate of 1%, a positive predictive value of 90% and a positive likelihood ratio of 13.2 to predict MIAC and HCA. However, the low sensitivity of 15% limits the clinical utility of this detection. CONCLUSION: CRP is a poor predictor of the occurrence of MIAC and HCA, even at early gestational ages.

BCNatal Barcelona Center for Maternal Fetal and Neonatal Medicine Barcelona Spain

Biomedical Research Center University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Genes and Environment Division of Epidemiology Norwegian Institute of Public Health Oslo University Oslo Norway

Department of Obstetrics and Gynecology Charles University Prague Faculty of Medicine Hradec Kralove Hradec Kralove Czech Republic

Department of Obstetrics and Gynecology Sahlgrenska academy Sahlgrenska University Hospital Gothenburg Sweden

Fingerland´s Department of Pathology Charles University Prague Faculty of Medicine Hradec Kralove University Hospital Hradec Kralove Hradec Kralove Czech Republic

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Clinical characteristics of colonization of the amniotic cavity in women with preterm prelabor rupture of membranes, a retrospective study

Presence of Chlamydia trachomatis DNA in the amniotic fluid in women with preterm prelabor rupture of membranes

Maternal white blood cell count cannot identify the presence of microbial invasion of the amniotic cavity or intra-amniotic inflammation in women with preterm prelabor rupture of membranes

Maternal serum C-reactive protein concentration and intra-amniotic inflammation in women with preterm prelabor rupture of membranes