Open AccessIntra-Amniotic Infection and Sterile Intra-Amniotic Inflammation in Cervical Insufficiency with Prolapsed Fetal Membranes: Clinical Implications
Author(s) -
Martina Chalupska,
Marian Kacerovský,
Jaroslav Stráník,
Miroslav Gregor,
Jan Malý,
Bo Jacobsson,
Ivana Musilová
Publication year - 2020
Publication title -
fetal diagnosis and therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.976
H-Index - 60
eISSN - 1421-9964
pISSN - 1015-3837
DOI - 10.1159/000512102
Subject(s) - medicine , cervical insufficiency , amniocentesis , amniotic fluid , cervical cerclage , inflammation , fetus , gestational age , amnion , chorioamnionitis , obstetrics , rupture of membranes , cervical dilation , pregnancy , gestation , gynecology , cervix , prenatal diagnosis , biology , cancer , genetics
The aim of this study was to identify the rates of 2 phenotypes of intra-amniotic inflammation: intra-amniotic infection (with microbial invasion of the amniotic cavity [MIAC]) and sterile intra-amniotic inflammation (without MIAC), and their outcomes, among women with cervical insufficiency with prolapsed fetal membranes. Methods of Study: This is a retrospective study of women admitted to the Department of Obstetrics and Gynecology, University Hospital Hradec Kralove between January 2014 and May 2020. Transabdominal amniocentesis to evaluate intra-amniotic inflammation (amniotic fluid interleukin-6) and MIAC (culturing and molecular biology methods) was performed as part of standard clinical management. Results: In total, 37 women with cervical insufficiency and prolapsed fetal membranes were included; 11% (4/37) and 43% (16/37) of them had intra-amniotic infection and sterile intra-amniotic inflammation, respectively. In women with intra-amniotic infection and sterile intra-amniotic inflammation, we noted shorter intervals between admission and delivery (both p < 0.0001), and lower gestational age at delivery ( p < 0.0001 and p = 0.004) and percentiles of birth/abortion weight ( p = 0.03 and p = 0.009, respectively) than in those without intra-amniotic inflammation. Conclusions: Both phenotypes of intra-amniotic inflammation, with sterile intra-amniotic inflammation being more frequent, are associated with worse outcomes in pregnancies with cervical insufficiency with prolapsed fetal membranes.