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Published on: December 31, 2015
A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent
Jyh Kae Nien1, Bo Hyun Yoon, Jimmy Espinoza
1Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.
Objective:
Matrix metalloproteinase-8 (MMP-8) is an enzyme that is released during neutrophil activation. MMP-8 amniotic fluid concentrations are elevated not only in patients with intra-amniotic infection, but also in patients with negative amniotic fluid cultures who deliver preterm neonates. The objective of this study was to determine whether the results of a rapid MMP-8 bedside test predict imminent preterm delivery. This test can be performed in 15 minutes and without laboratory equipment.
Study Design:
Amniotic fluid was retrieved from 331 patients admitted with increased preterm uterine contractions and intact membranes who met the inclusion criteria. Amniotic fluid was processed for microbial cultures, Gram stain, glucose concentration, and white blood cell count. Amniotic fluid samples were stored, and the MMP-8 rapid test was performed after delivery. End points included spontaneous preterm delivery within 48 hours, 7 days, and 14 days. Diagnostic indices, predictive values, and likelihood ratios were calculated.
Results:
The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days was 11.6% (38/327), 20.2% (66/327), and 24.5% (80/327), respectively (4 patients with augmentation of labor were excluded). A positive MMP-8 rapid test had a positive predictive value of 70% (23/33) for the identification of patients who delivered spontaneously within 48 hours, and 94% (31/33) for patients who were delivered within 7 days and 14 days (likelihood ratios: 17.5 [95% CI, 9-33.9], 61.3 [95% CI, 15.1-250], and 50 [95% CI, 12-196], respectively).
Conclusion:
The MMP-8 rapid test can identify patients at risk for preterm delivery within 7 days and 14 days. Moreover, a positive MMP-8 rapid test result can identify patients with intra-amniotic infection/inflammation with a high sensitivity and specificity. This rapid test will give clinicians a fast and accurate assessment of the inflammatory status of the amniotic cavity and allow for better identification of patients at risk for impending preterm delivery.
Insights
A rapid bedside test for matrix metalloproteinase-8 (MMP-8) effectively identifies patients at risk for preterm delivery within 7 to 14 days. This tool offers a quick and accurate assessment of amniotic cavity inflammation, aiding in risk identification.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Biochemistry
Background:
- Elevated amniotic fluid concentrations of matrix metalloproteinase-8 (MMP-8), an enzyme released during neutrophil activation, are observed in patients with intra-amniotic infection and those delivering preterm neonates.
- MMP-8 levels are elevated even in cases with negative amniotic fluid cultures, suggesting its role in preterm delivery prediction.
Purpose of the Study:
- To evaluate the predictive capability of a rapid MMP-8 bedside test for imminent preterm delivery.
- To determine if this 15-minute, equipment-free test can accurately identify patients at risk for delivering preterm.
Main Methods:
- Amniotic fluid samples were collected from 331 patients presenting with preterm labor and intact membranes.
- Samples underwent microbial cultures, Gram stain, glucose concentration, and white blood cell count analysis.
- A rapid MMP-8 bedside test was performed post-delivery, with outcomes assessed for spontaneous preterm delivery within 48 hours, 7 days, and 14 days.
Main Results:
- The prevalence of spontaneous preterm delivery was 11.6% within 48 hours, 20.2% within 7 days, and 24.5% within 14 days.
- A positive MMP-8 rapid test showed a positive predictive value of 70% for delivery within 48 hours and 94% for delivery within 7 and 14 days.
- Likelihood ratios for positive MMP-8 tests were significant, indicating strong predictive power for preterm delivery.
Conclusions:
- The MMP-8 rapid test is a valuable tool for identifying patients at risk of preterm delivery within 7 and 14 days.
- A positive MMP-8 rapid test result demonstrates high sensitivity and specificity for detecting intra-amniotic infection/inflammation.
- This rapid test provides clinicians with a fast, accurate assessment of amniotic cavity inflammation, improving the identification of patients at risk for impending preterm delivery.
