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Published on: November 20, 2015
Late preterm prelabor rupture of fetal membranes: fetal inflammatory response and neonatal outcome
Ivana Musilova1, Ctirad Andrys1, Marcela Drahosova1
1Department of Clinical Immunology and Allergy, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic.
Abstract:
BackgroundTo characterize the influence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI) on the intensity of the fetal inflammatory response and the association between the presence of the fetal inflammatory response syndrome (FIRS) and short-term neonatal morbidity in the preterm prelabor rupture of membranes (PPROM) between the gestational ages of 34 and 37 weeks.MethodsOne hundred and fifty-nine women were included in the study. The umbilical cord blood interleukin (IL)-6 concentrations were determined using enzyme-linked immunosorbent assay kits. FIRS was defined based on the umbilical cord blood IL-6 concentration and the presence of funisitis and/or chorionic plate vasculitis.ResultsWomen with both MIAC and IAI had the highest median umbilical cord blood IL-6 concentrations and highest rates of FIRS. Women with FIRS had the higher rates of early-onset sepsis and intraventricular hemorrhage grades I and II when FIRS was characterized based on the umbilical cord blood IL-6 concentrations and the histopathological findings.ConclusionThe presence of both MIAC and IAI was associated with a higher fetal inflammatory response and a higher rate of FIRS. Different aspects of short-term neonatal morbidity were related to FIRS when defined by umbilical cord blood IL-6 concentrations and the histopathology of the placenta.
Insights
Microbial invasion and inflammation in the amniotic cavity increase fetal inflammation and fetal inflammatory response syndrome (FIRS) in preterm prelabor rupture of membranes (PPROM). FIRS is linked to neonatal sepsis and intraventricular hemorrhage.
Area of Science:
- Perinatal Medicine
- Neonatal Research
- Obstetrics
Background:
- Microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation (IAI) are significant complications.
- Understanding their impact on fetal inflammatory response is crucial for preterm prelabor rupture of membranes (PPROM).
Purpose of the Study:
- To investigate the link between MIAC/IAI and fetal inflammatory response intensity.
- To assess the association between fetal inflammatory response syndrome (FIRS) and neonatal morbidity in PPROM (34-37 weeks).
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) for umbilical cord blood IL-6.
- Histopathological examination for funisitis and chorionic plate vasculitis.
- FIRS defined by IL-6 levels and histopathology.
Main Results:
- Combined MIAC and IAI showed highest IL-6 levels and FIRS rates.
- FIRS presence correlated with increased early-onset sepsis.
- FIRS associated with higher rates of intraventricular hemorrhage (grades I-II).
Conclusions:
- MIAC and IAI together elevate fetal inflammatory response and FIRS risk.
- FIRS, defined by IL-6 and placental pathology, relates to specific neonatal morbidities.
