- 作者：C. Andrew Combs ; Michael Gravett ; Thomas J. Garite ; Durlin E. Hickok ; Jodi Lapidus ; Richard Porreco ; Julie Rael ; Thomas Grove ; Terry K. Morgan ; William Clewell ; Hugh Miller ; David Luthy ; Leonardo Pereira ; Michael Nageotte ; Peter A. Robilio ; Stephen Fortunato ; Hyagriv Simhan ; Jason K. Baxter ; Erol Amon ; Albert Franco ; Kenneth Trofatter ; et al.
- 关键词：chorioamnionitis ; intraamniotic infection ; intraamniotic inflammation ; microbial invasion of the amniotic cavity ; morbidity ; preterm birth ; preterm labor
- 刊名：American Journal of Obstetrics and Gynecology
- 出版年：February, 2014
- 年：2014
- 卷：210
- 期：2
- 页码：125.e1-125.e15
- 全文大小：1088 K
Objective
The purpose of this study was to compare intraamniotic inflammation vs microbial invasion of the amniotic cavity (MIAC) as聽predictors of adverse outcome in preterm labor with intact membranes.Study Design
Interleukin-6 (IL-6) was measured in prospectively collected amniotic fluid from 305 women with preterm labor. MIAC聽was defined by amniotic fluid culture and/or detection of microbial 16S ribosomal DNA. Cases were categorized into 5聽groups: infection (MIAC; IL-6, 鈮?1.3 ng/mL); severe inflammation (no聽MIAC; IL-6, 鈮?1.3 ng/mL); mild inflammation (no MIAC; IL-6, 2.6-11.2 ng/mL); colonization (MIAC; IL-6, <2.6 ng/mL); negative (no MIAC; IL-6, <2.6 ng/mL).
Results
The infection (n聽= 27) and severe inflammation (n聽= 36) groups had similar latency (median, <1 day and 2 days, respectively) and similar rates of composite perinatal morbidity and mortality (81% and 72%, respectively). The colonization (n聽= 4) and negative (n聽= 195) groups had similar outcomes (median latency, 23.5 and 25 days; composite morbidity and mortality rates, 21% and 25%, respectively). The mild inflammation (n聽= 47) groups had outcomes that were intermediate to the severe inflammation and negative groups (median latency, 7 days; composite morbidity and mortality rates, 53%). In logistic regression adjusting for gestational age at enrollment, IL-6 鈮?1.3 and 2.6-11.2 ng/mL, but not MIAC, were associated significantly with composite morbidity and mortality rates (odds ratio [OR], 4.9; 95% confidence interval [CI], 2.2-11.2, OR, 3.1; 95% CI, 1.5-6.4, and OR, 1.8; 95% CI, 0.6-5.5, respectively).
Conclusion
We confirmed previous reports that intraamniotic inflammation is associated with adverse perinatal outcomes whether or not intraamniotic microbes are detected. Colonization without inflammation appears relatively benign. Intraamniotic inflammation is not simply present or absent but also has degrees of severity that correlate with adverse outcomes. We propose the designation amniotic inflammatory response syndrome to denote the adverse outcomes that are associated with intraamniotic inflammation.