The main aim of the study was to determine progranulin levels in amniotic and cervical fluid samples from pregnancies complicated by preterm prelabor rupture of membranes (PPROM) or preterm labor with intact membranes (PTL), with concomitant microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. A total of 104 and 108 women with PPROM and PTL, respectively, were included. Paired amniotic and cervical fluid samples were obtained using transabdominal amniocentesis and Dacron polyester swabs, respectively. Progranulin levels were assessed with an enzyme-linked immunosorbent assay. Women with PPROM and PTL were divided into subgroups based on microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. Differences in progranulin levels among the PPROM and PTL subgroups were found in amniotic fluid: (a) PPROM: intra-amniotic infection: 51.8 pg/mL, sterile intra-amniotic inflammation: 52.8 pg/mL, colonization: 36.4 pg/mL, and negative amniotic fluid: 35.0 pg/mL; p < 0.0001; (b) PTL: intra-amniotic infection: 75.3 pg/mL, sterile intra-amniotic inflammation: 54.0 pg/mL, and negative amniotic fluid: 39.1 pg/mL; p < 0.0001. The corresponding differences were not found in cervical fluid: (a) PPROM: p = 0.14; (b) PTL: p = 0.53. In conclusion, amniotic fluid progranulin levels increased in PPROM and PTL cases with concomitant intra-amniotic inflammation, regardless of whether microbial invasion of the amniotic cavity was present or absent.

• Keywords
• Amniotic fluid, Intra-amniotic inflammation, Invasive sampling, Microbial invasion of the amniotic cavity, Non-invasive sampling, Preterm delivery,
• MeSH
• Amniocentesis MeSH
• Cervix Uteri * metabolism   MeSH
• Chorioamnionitis metabolism   MeSH
• Adult MeSH
• Humans MeSH
• Amniotic Fluid * metabolism   MeSH
• Obstetric Labor, Premature metabolism   MeSH
• Fetal Membranes, Premature Rupture * metabolism   MeSH
• Premature Birth * metabolism   MeSH
• Progranulins * metabolism   MeSH
• Retrospective Studies MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• GRN protein, human MeSH Browser
• Progranulins * MeSH

OBJECTIVE: The main aim of this study was to determine the relationship between the maternal white blood cell (WBC) count at the time of hospital admission in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) and the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI). The second aim was to test WBC diagnostic indices with respect to the presence of MIAC and/or IAI. METHODS: Four hundred and seventy-nine women with singleton pregnancies complicated by PPROM, between February 2012 and June 2017, were included in this study. Maternal blood and amniotic fluid samples were collected at the time of admission. Maternal WBC count was assessed. Amniotic fluid interleukin-6 (IL-6) concentration was measured using a point-of-care test, and IAI was characterized by an IL-6 concentration of ≥ 745 pg/mL. MIAC was diagnosed based on a positive polymerase chain reaction result for the Ureaplasma species, Mycoplasma hominis, and/or Chlamydia trachomatis and/or for the 16S rRNA gene. RESULTS: Women with MIAC or IAI had higher WBC counts than those without (with MIAC: median, 12.8 × 109/L vs. without MIAC: median, 11.9 × 109/L; p = 0.0006; with IAI: median, 13.7 × 109/L vs. without IAI: median, 11.9 × 109/L; p < 0.0001). When the women were divided into four subgroups based on the presence of MIAC and/or IAI, the women with both MIAC and IAI had a higher WBC count than those with either IAI or MIAC alone, and those without MIAC and IAI [both MIAC and IAI: median, 14.0 × 109/L; IAI alone: 12.1 × 109/L (p = 0.03); MIAC alone: 12.1 × 109/L (p = 0.0001); and without MIAC and IAI: median, 11.8 × 109/L (p < 0.0001)]. No differences in the WBC counts were found among the women with IAI alone, MIAC alone, and without MIAC and IAI. CONCLUSION: The women with both MIAC and IAI had a higher maternal WBC count at the time of hospital admission than the remaining women with PPROM. The maternal WBC count at the time of admission showed poor diagnostic indices for the identification of the presence of both MIAC and IAI. Maternal WBC count at the time of admission cannot serve as a non-invasive screening tool for identifying these complications in women with PPROM.

• MeSH
• Chorioamnionitis diagnosis   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Amniotic Fluid microbiology   MeSH
• Leukocyte Count * MeSH
• Fetal Membranes, Premature Rupture * MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: To evaluate maternal serum C-reactive protein (CRP) concentrations in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) in relation to the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI). METHODS: Two hundred and eighty-seven women with singleton pregnancies complicated by PPROM between 2014 and 2016 were included in this study. Maternal blood and amniotic fluid samples were collected at the time of admission. Maternal serum CRP concentration was measured using a high-sensitivity immunoturbidimetric assay. Interleukin-6 (IL-6) concentration was measured using a point-of-care test. MIAC was diagnosed based on a positive polymerase chain reaction result for Ureaplasma species, Mycoplasma hominis, and/or Chlamydia trachomatis and for the 16S rRNA gene. IAI was characterized by an amniotic fluid IL-6 concentration of ≥ 745 pg/mL. RESULT: Women with MIAC and IAI had higher maternal serum CRP concentrations than did women without (with MIAC: median 6.9 mg/L vs. without MIAC: median 4.9 mg/L; p = 0.02; with IAI: median 8.6 mg/L vs. without IAI: median 4.7 mg/L; p < 0.0001). When women were split into four subgroups based on the presence of MIAC and/or IAI, women with the presence of both MIAC and IAI had higher maternal serum CRP than did women with IAI alone, with MIAC alone, and women without MIAC and IAI (both MIAC and IAI: median: 13.1 mg/L; IAI alone: 6.0 mg/L; MIAC alone: 3.9 mg/L; and without MIAC and IAI: median 4.8 mg/L; p < 0.0001). The maternal serum CRP cutoff value of 17.5 mg/L was the best level to identify the presence of both MIAC and IAI, with sensitivity of 47%, specificity of 96%, positive predictive value of 42%, negative predictive value of 96%, and the positive likelihood ratio of 10.9. CONCLUSION: The presence of both MIAC and IAI was associated with the highest maternal serum CRP concentrations. Maternal serum CRP concentration in women with PPROM at the time of admission can rule out the presence of the combined condition of both MIAC and IAI, therefore, it may serve as a non-invasive screening tool to distinguish between women with PPROM who are at high or at low risk for the presence of both MIAC and IAI.

• MeSH
• Biomarkers MeSH
• C-Reactive Protein * MeSH
• Chorioamnionitis blood   diagnosis   microbiology   MeSH
• Adult MeSH
• Gestational Age MeSH
• Interleukin-6 metabolism   MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Amniotic Fluid metabolism   microbiology   MeSH
• Fetal Membranes, Premature Rupture blood   diagnosis   etiology   MeSH
• ROC Curve MeSH
• Pregnancy MeSH
• Delivery, Obstetric methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Biomarkers MeSH
• C-Reactive Protein * MeSH
• Interleukin-6 MeSH