PPROM
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- MeSH
- antibakteriální látky terapeutické užití MeSH
- císařský řez metody MeSH
- gestační stáří MeSH
- glukokortikoidy terapeutické užití MeSH
- infekční komplikace v těhotenství mikrobiologie terapie MeSH
- lidé MeSH
- nástup porodu účinky léků MeSH
- předčasná porodní činnost MeSH
- předčasný odtok plodové vody diagnóza farmakoterapie terapie MeSH
- předčasný porod etiologie MeSH
- těhotenství MeSH
- tokolytika terapeutické užití MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
BACKGROUND: The role of viral infections in preterm prelabor rupture of the membranes (PPROM) is not established. Studies on the presence of viral genomes in the amniotic fluid (AF) collected in pregnancies complicated by PPROM show contradictory outcomes. OBJECTIVES: To investigate AF samples of PPROM pregnancies for the presence of viral genomes. STUDY DESIGN: AF samples from patients with PPROM were collected during a 4-year (2008-2012) observational study. 174 women were included with selection criteria of singleton pregnancy, PPROM, and maternal age of 18 years and above. PCR was used for detection of human cytomegalovirus (HCMV), herpes simplex virus (HSV), parvovirus B19, human adenoviruses (HAdV), enteroviruses (EV) and human parechovirus (HPeV). The selection of these viral targets was based on literature regarding screening of AF for presence of viral genomes. RESULTS: Only a single sample was positive out of the 174 tested AFs, HCMV DNA was detected. CONCLUSIONS: PPROM is not associated with active viral infections.
INTRODUCTION: To determine the amniotic fluid glucose levels in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) based on the presence of microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. METHODS OF STUDY: A total of 142 women with singleton pregnancies complicated by PPROM between gestational ages 24 + 0 and 36 + 6 weeks were included. Amniocentesis was performed at the time of admission. The assessments of microbial invasion of the amniotic cavity (using both cultivation and non-cultivation techniques) and intra-amniotic inflammation (amniotic fluid interleukin-6 levels ≥ 3000 pg/mL) were performed on all the women. Based on the presence of microbial invasion of the amniotic cavity and/or intra-amniotic inflammation, the women were further categorized into the subgroups: (i) intra-amniotic infection (the presence of both microbial invasion of the amniotic cavity and intra-amniotic inflammation); (ii) sterile intra-amniotic inflammation (the presence of intra-amniotic inflammation without microbial invasion of the amniotic cavity); (iii) colonization (the presence of microbial invasion of the amniotic cavity without intra-amniotic inflammation); and (iv) negative amniotic fluid (the absence of either microbial invasion of the amniotic cavity or intra-amniotic inflammation). Amniotic fluid glucose levels were assessed using enzymatic reference method with hexokinase. RESULTS: There was a difference in the amniotic fluid glucose levels among the women with intra-amniotic infection, sterile intra-amniotic inflammation, colonization, and those with negative amniotic fluid (p < .0001). No difference was found in the amniotic fluid glucose levels between women with intra-amniotic infection and those with sterile intra-amniotic inflammation [infection: median 11.6 mg/dL (0.7 mmol/L) vs. sterile: median 6.3 mg/dL (0.4 mmol/L); p = .41] and between women with colonization and negative amniotic fluid [colonization: median 21.6 mg/dL (1.2 mmol/L) vs. negative: median 23.4 mg/dL (1.3 mmol/L; p = .67]. Women with intra-amniotic infection and sterile intra-amniotic inflammation had lower amniotic fluid glucose levels than women with colonization and with negative amniotic fluid in crude analysis as well as after adjustment for gestational age at sampling. Amniotic fluid glucose level of 10 mg/dL (0.56 mmol/L) was the optimal concentration for the identification of intra-amniotic inflammation in women with PPROM. CONCLUSIONS: The presence of intra-amniotic inflammation was associated with lower amniotic fluid glucose levels in singleton pregnancies complicated with PPROM. An amniotic fluid glucose level of 10 mg/dL (0.56 mmol/L) was the optimal concentration for the identification of intra-amniotic inflammation in PPROM pregnancies. In the absence of better amniotic fluid markers, amniotic glucose could be used as a marker of intra-amniotic inflammation, with very good specificity in PPROM pregnancies.
- MeSH
- biologické markery analýza MeSH
- chorioamnionitida * epidemiologie etiologie MeSH
- gestační stáří MeSH
- glukosa MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- plodová voda chemie MeSH
- přátelé MeSH
- předčasný odtok plodové vody * etiologie MeSH
- těhotenství MeSH
- zánět komplikace MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Preterm prelabor rupture of membranes (PPROM) complicated by microbial invasion of the amniotic cavity (MIAC) leading to histological chorioamnionitis (HCA) significantly impacts perinatal morbidity. Unfortunately, no well-established tool for identifying PPROM patients threatened by these disorders is available. METHODOLOGY/PRINCIPAL FINDINGS: We performed an unbiased exploratory analysis of amniotic fluid proteome changes due to MIAC and HCA. From among the top five proteins that showed the most profound and significant change, we sought to confirm results concerning cathelicidin (P49913, CAMP_HUMAN), since an ELISA kit was readily available for this protein. In our exploratory proteomic study, cathelicidin showed a ∼6-fold higher concentration in PPROM patients with confirmed MIAC and HCA. We verified significantly higher levels of cathelicidin in exploratory samples (women without both MIAC and HCA: median 1.4 ng/ml; women with both conditions confirmed: median 3.6 ng/ml; p = 0.0003). A prospective replication cohort was used for independent validation and for assessment of cathelicidin potential to stratify women with MIAC leading to HCA from women in whom at least one of these conditions was ruled out. We confirmed the association of higher amniotic fluid cathelicidin levels with MIAC leading to HCA (the presence of both MIAC and HCA: median 3.1 ng/ml; other women: median 1.4 ng/ml; p<0.0001). A cathelicidin concentration of 4.0 ng/ml was found to be the best cut-off point for identifying PPROM women with both MIAC and HCA. When tested on the validation cohort, a sensitivity of 48%, a specificity of 90%, a likelihood ratio of 5.0, and an area under receiver-operating characteristic curve of 71% were achieved for identification of women with MIAC leading to HCA. CONCLUSIONS: Our multi-stage study suggests cathelicidin as a candidate marker that should be considered for a panel of amniotic fluid proteins permitting identification of PPROM women with MIAC leading to HCA.
- MeSH
- chorioamnionitida diagnóza metabolismus MeSH
- dospělí MeSH
- ELISA metody MeSH
- gestační stáří MeSH
- kationické antimikrobiální peptidy biosyntéza MeSH
- koncentrace vodíkových iontů MeSH
- leukocyty metabolismus MeSH
- lidé MeSH
- neutrofily metabolismus MeSH
- peptidy chemie MeSH
- plodová voda metabolismus MeSH
- pravděpodobnostní funkce MeSH
- předčasný odtok plodové vody diagnóza metabolismus mikrobiologie MeSH
- proteomika metody MeSH
- ROC křivka MeSH
- senzitivita a specificita MeSH
- těhotenství MeSH
- trypsin chemie MeSH
- zánět metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: PROM and pPROM and early onset neonatal sepsis negatively affect the neonatal perinatal mortality and morbidity. OBJECTIVES: The target of the work was to evaluate the relationship between chorioamnionitis, funisitis and PROM, pPROM and the risk of early onset neonatal sepsis. METHODS: We examined 152 samples of the placenta and umbilical cord, histologically and microbiologically, in 53 women without PROM, 52 women with PROM and 47 women with pPROM. RESULTS: We demonstrated a statistically significant relationship of chorioamnionitis and funisitis to the risk of early-onset neonatal sepsis. We demonstrated no relationship between pathological findings in the placenta and PROM or pPROM. CONCLUSIONS: The histological findings of an amniotic-type placentitis can particularly be used for supporting or possibly excluding the diagnosis of early onset neonatal sepsis.
- MeSH
- chorioamnionitida patologie MeSH
- infekční komplikace v těhotenství patologie MeSH
- lidé MeSH
- nemoci novorozenců patologie MeSH
- novorozenec MeSH
- perinatální mortalita MeSH
- placenta patologie MeSH
- předčasný odtok plodové vody patologie MeSH
- pupečník patologie MeSH
- rizikové faktory MeSH
- sepse patologie MeSH
- těhotenství MeSH
- zánět patologie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
