| 1. |
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| 2. |
- Cobo, Teresa, et al.
(författare)
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A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes: analyses of multiple proteins in the amniotic fluid.
- 2012
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the best prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes (PPROM) using selected candidate proteins in the amniotic fluid (AF). Material and methods: Prospective cohort study. Twenty-six AF proteins were assayed by a multiple immunoassay from 107 women with membranes rupture from 23+0 to 36+6 weeks. The Czech Republic policy is active management, and the majority of women were delivered within 72 h after the rupture of membranes, except for women with PPROM <28+0 weeks who were managed conservatively. The best predictive models to diagnose histological chorioamnionitis and funisitis were calculated by logistic regression depending on the gestational age (GA) at membrane rupture. Results: Both IL-6 and a combination of IL-10, and migration inhibiting factor (MIF) were the best predictive models of histological chorioamnionitis and funisitis, respectively, with sensitivity, specificity, positive and negative predictive values and positive likelihood ratio (LR+) of 62, 83, 37, 93 and 3.6 and of 63, 91, 53, 94 and 7.0, respectively. Depending on whether GA at membrane rupture was <32 or ≥ 32 weeks, IL-10, alone or in combination with MIF and triggering receptor expressed on myeloid cells-1, was the strongest inflammatory biomarker for funisitis (LR+10.6 and 36.6, respectively). Conclusion: Regardless of the GA at membrane rupture, IL-6 from the AF was the best predictor of histological chorioamnionitis. Amniotic fluid IL-10 was notably accurate in the prediction of funisitis.
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| 3. |
- Cobo, Teresa, et al.
(författare)
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A Rapid Amniotic Fluid Interleukin-6 Assessment for the Identification of Intra-Amniotic Inflammation in Women with Preterm Labor and Intact Membranes.
- 2021
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Ingår i: Fetal diagnosis and therapy. - : S. Karger AG. - 1421-9964 .- 1015-3837. ; 48:5, s. 327-332
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Tidskriftsartikel (refereegranskat)abstract
- A multivariable predictive model has recently been developed with good accuracy to predict spontaneous preterm delivery within 7 days in women with preterm labor (PTL) and intact membranes. However, this model measures amniotic fluid (AF) interleukin (IL)-6 concentrations using the ELISA method, thereby limiting clinical implementation. The main objectives of this study were to validate the automated immunoassay as a quantitative method to measure AF IL-6 in women with PTL and to evaluate the diagnostic performance of AF IL-6 alone and as part of a multivariable predictive model to predict spontaneous delivery in 7 days with this automated method.This is a retrospective observational study in women with PTL below 34 weeks who underwent amniocentesis to rule out microbial invasion of the amniotic cavity. Women with clinical signs of chorioamnionitis, cervical length measurement at admission >5th centile, maternal age <18 years, and no consent to perform amniocentesis for this indication were excluded. The local Institutional Review Boards approved the study (HCB/2019/0940). Analysis of AF IL-6 Concentrations: AF IL-6 concentrations were measured using an automated Cobas e602 electrochemiluminescence immunoanalyzer and Human IL-6 Quantikine ELISA kit.Of the entire study group (n = 100), 38 women spontaneously delivered within 7 days after admission. Both laboratory methods showed good agreement (intraclass correlation coefficient: 0.937 (95% confidence interval [CI] 0.908-0.957); p < 0.001). Diagnostic performance of AF IL-6 to predict spontaneous delivery within 7 days when it was included in the multivariable predictive model showed an area under the receiver operating characteristic curve of 0.894 (95% CI 0.799-0.955), sensitivity of 97%, specificity of 74%, positive predictive value of 73%, negative predictive value of 97%, positive likelihood ratio (LR) of 3.7, and negative LR of 0.045.While both analytical methods were comparable for measuring AF IL-6 concentrations in women with PTL, the Cobas immunoanalyzer provided rapid diagnosis of intra-amniotic inflammation within minutes. The predictive model showed a good diagnostic performance to target women at high risk of spontaneous delivery within 7 days.
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| 4. |
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| 5. |
- Cobo, Teresa, et al.
(författare)
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Intra-amniotic inflammation predicts microbial invasion of the amniotic cavity but not spontaneous preterm delivery in preterm prelabor membrane rupture.
- 2012
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To predict microbial invasion of the amniotic cavity (MIAC) and spontaneous preterm delivery within seven days using a panel of selected proteins from amniotic fluid in a Swedish population of preterm prelabor membrane rupture (PPROM). Design. Prospective cohort study. Setting. Evaluation of intra-amniotic inflammation in preterm premature rupture of membranes. Population. Sixty-six pregnant women with preterm prelabor membrane rupture at 22(+0-) 33(+6) weeks' gestational age. Methods. Twenty-seven amniotic fluid proteins were assayed by a multiple immunoassay. Main outcome measures. The intra-amniotic inflammatory response was evaluated according to the presence of MIAC and the risk of spontaneous preterm delivery within seven days. A prediction model was constructed using logistic regression. Results. The overall rates of MIAC and spontaneous preterm delivery within seven days were 20% and 50%, respectively. There was a higher inflammatory response in women with MIAC than without. Earlier gestational age at delivery and lower birthweight were observed in the presence of microbial invasion of the amniotic cavity. Amniotic fluid Interleukin (IL)-6 and IL-10 were the best predictors of MIAC in terms of sensitivity (69%), specificity (81%), positive predictive value (47%), negative predictive value (91%) and positive likelihood ratio of 3.6. There were no differences in intra-amniotic inflammatory response according to the risk of spontaneous preterm delivery within seven days. Conclusion. Amniotic fluid IL-6 and IL-10 are the best inflammatory biomarkers to predict MIAC in women with PPROM. Intra-amniotic inflammation does not predict the occurrence of spontaneous preterm delivery within seven days of PPROM.
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| 6. |
- Cobo, Teresa, et al.
(författare)
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Noninvasive Sampling of the Intrauterine Environment in Women with Preterm Labor and Intact Membranes.
- 2018
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Ingår i: Fetal diagnosis and therapy. - : S. Karger AG. - 1421-9964 .- 1015-3837. ; 43:4, s. 241-249
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Forskningsöversikt (refereegranskat)abstract
- Spontaneous preterm birth has enormous consequences for newborns, children, and families. Intra-amniotic inflammation (IAI) is the leading cause of spontaneous preterm delivery, mainly at earlier gestational ages. Amniocentesis is the only method used to identify IAI in clinical practice. Although it is an invasive procedure with a very low risk of complications, many women and physicians are hesitant about amniocentesis on this indication. This has been an incentive to explore IAI and the intra-amniotic environment through noninvasive techniques, such as sampling cervical mucus, vaginal fluid, or maternal blood. With this overview, we aim to provide a concise update on the state of the art of the noninvasive sampling of the intrauterine environment in women with preterm labor and intact membranes. So far, it is unknown whether this screening helps improve our knowledge about the impact of IAI on the neonatal and long-term outcome, but we believe it merits this review.
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| 7. |
- Cobo, Teresa, et al.
(författare)
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Risk factors for spontaneous preterm delivery.
- 2020
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479. ; 150:1, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- There is a substantial variation in rates of preterm delivery between different parts of the world. The understanding of these variations, as well as the biological mechanisms behind spontaneous preterm delivery, is limited. Although the benefit of antenatal interventions has been shown to be limited, using well-known risk factors for spontaneous preterm delivery to select the correct pregnant women for targeted interventions is important from both a medical and caregiving perspective.To provide an introduction to a substantial research area dealing with risk factors of spontaneous preterm delivery.Risk factors in this review were classified as demographical, obstetrical, and gynecological and those related to the current pregnancy according to high-quality evidence of recent literature.An introduction to a substantial research area in maternal and fetal medicine was provided that might help clinicians to better understand the risk factors related to preterm delivery and select the correct pregnant women for targeted interventions.
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| 8. |
- Hallingström, Maria, et al.
(författare)
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The association between selected mid-trimester amniotic fluid candidate proteins and spontaneous preterm delivery
- 2020
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Ingår i: Journal of Maternal-Fetal and Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 33:4, s. 583-592
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore inflammatory response and identify early potential biomarkers in mid-trimester amniotic fluid associated with subsequent spontaneous preterm delivery (PTD). Methods: A cohort study was performed at Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, between 2008 and 2010. Amniotic fluid was collected from consecutive women undergoing mid-trimester transabdominal genetic amniocentesis at 14–19 gestational weeks. Clinical data and delivery outcome variables were obtained from medical records. The analysis included 19 women with spontaneous PTD and 118 women who delivered at term. A panel of 26 candidate proteins was analyzed using Luminex xMAP technology. Candidate protein concentrations were analyzed with ANCOVA and adjusted for plate effects. Results: The median gestational age at delivery was 35 + 3 weeks in women with spontaneous PTD and 40 + 0 weeks in women who delivered at term. Nominally significantly lower amniotic fluid levels of adiponectin (PTD: median 130,695 pg/mL (IQR 71,852–199,414) vs term: median 185,329 pg/mL (IQR (135,815–290,532)), granulocyte-macrophage colony stimulating factor (PTD: median 137 pg/mL (IQR 74–156) vs term: median 176 pg/mL (IQR 111–262)), and macrophage migration inhibitory factor (PTD: median 3025 pg/mL (IQR 1885–3891) vs term: median 3400 pg/mL (IQR 2181–5231)) were observed in the spontaneous PTD group, compared with the term delivery group, after adjusting for plate effects. No significant differences remained after Bonferroni correction for multiple comparisons. Conclusions: Our results are important in the process of determining the etiology behind spontaneous PTD but due to the non-significance after Bonferroni correction, the results should be interpreted with caution. Further analyses of larger sample size will be required to determine whether these results are cogent and to examine whether microbial invasion of the amniotic cavity or intra-amniotic inflammation occurs in asymptomatic women in the mid-trimester with subsequent spontaneous PTD.
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| 9. |
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| 10. |
- Kacerovsky, Marian, et al.
(författare)
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Preterm Prelabor Rupture of Membranes between 34 and 37 Weeks: A Point-of-Care Test of Vaginal Fluid Interleukin-6 Concentrations for a Noninvasive Detection of Intra-Amniotic Inflammation.
- 2018
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Ingår i: Fetal diagnosis and therapy. - : S. Karger AG. - 1421-9964 .- 1015-3837. ; 43:3
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate whether a previously reported vaginal fluid point-of-care interleukin (IL)-6 cut-off value of 2,500 pg/mL can be used for the identification intra-amniotic inflammation in women with preterm prelabor rupture of membranes (PPROM) between 34 and 37 weeks.A prospective cohort study was conducted in women with singleton gestation complicated by PPROM between 34 + 0 and 36 + 6 weeks. Vaginal fluid was successfully obtained in 118 women from the posterior vaginal fornix via aspiration using a sterile urine sample tube with a suction tip. Amniotic fluid was obtained via transabdominal amniocentesis. IL-6 concentrations were assessed in both fluids immediately after sampling. Intra-amniotic inflammation was defined as an amniotic fluid point-of-care IL-6 concentration of ≥745 pg/mL.The tested vaginal fluid IL-6 cut-off value had a sensitivity of 91%, specificity of 91%, positive predictive value of 50%, negative predictive value of 99%, positive likelihood ratio of 9.7, and negative likelihood ratio of 0.1 for the identification of intra-amniotic inflammation.The point-of-care vaginal fluid IL-6 test with a cut-off value of 2,500 pg/mL shows good sensitivity, specificity, and negative predictive value for the identification of intra-amniotic inflammation in PPROM between 34 and 37 weeks.
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| 11. |
- Kacerovsky, Marian, et al.
(författare)
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Scavenger receptor for hemoglobin in preterm prelabor rupture of membranes pregnancies complicated by histological chorioamnionitis.
- 2012
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We sought to evaluate the distribution of scavenger receptor for hemoglobin positive (CD163(+)) cells in the placenta and fetal membranes from pregnancies complicated by preterm prelabor rupture of membranes with respect to the presence and absence of histological chorioamnionitis. Methods: Sixty-two women with singleton pregnancies with a gestational age between 24+0 and 36+6 weeks were included in a prospective cohort study. CD163 was evaluated by immunohistochemistry in the placenta and fetal membranes. The number of CD163(+) cells and neutrophils was counted in the following locations: fetal membranes' amnion, chorion, and decidua, as well as the placenta's amnion, chorionic plate, subchorionic fibrin, stem villi, terminal villi, and decidua. Results: CD163(+) cells were found in all compartments of the placenta and the fetal membranes regardless of the inflammatory status. A positive correlation between the number of CD163(+) cells and neutrophils in the subchorionic fibrin and the chorionic plate was found. The number of CD163(+) cells was higher in the placental subchorionic fibrin and chorionic plate when histological chorioamnionitis was present. Conclusion: The presence of histological chorioamnionitis affected the number of CD163(+) cells in the placental chorionic plate and in the subchorionic fibrin but not in the fetal membranes.
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| 12. |
- Musilova, Ivana, et al.
(författare)
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Interleukin-6 measured using the automated electrochemiluminescence immunoassay method for the identification of intra-amniotic inflammation in preterm prelabor rupture of membranes.
- 2020
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954. ; 33:11, s. 1919-1926
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to compare the amniotic fluid interleukin (IL)-6 concentrations measured using the automated electrochemiluminescence immunoassay method and ELISA, and to establish an IL-6 concentration cut-off value for intra-amniotic inflammation (IAI) in preterm prelabor rupture of membranes (PPROM), which can be used in the automated electrochemiluminescence immunoassay method.A total of 120 women with PPROM were included in this study. Amniotic fluid samples were obtained via transabdominal amniocentesis. IL-6 concentrations were assessed using both the automated electrochemiluminescence immunoassay method and ELISA, the current gold standard. IAI was defined as an amniotic fluid IL-6 concentration of ≥ 2600 pg/mL measured using ELISA.A correlation between both assays was found (Spearman's rho = 0.97; p < 0.0001). Based on the receiver-operating characteristic curve for the identification of IAI (area under the curve = 0.99), a cut-off value of ≥ 3000pg/mL was selected for the automated electrochemiluminescence immunoassay method with a sensitivity of 88%, specificity of 99%, positive predictive value of 97%, negative predictive value of 96%, and likelihood ratio of 76.
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| 13. |
- Musilova, Ivana, et al.
(författare)
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Intraamniotic inflammation and umbilical cord blood interleukin-6 concentrations in pregnancies complicated by preterm prelabor rupture of membranes.
- 2017
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954. ; 30:8, s. 900-910
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate umbilical cord blood interleukin (IL)-6 concentrations and the occurrence of fetal inflammatory response syndrome (FIRS) with respect to microbial invasion of the amniotic cavity (MIAC) and/or intraamniotic inflammation (IAI) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM).One-hundred-eighty-eight women with singleton pregnancies complicated by PPROM between gestational ages of 24+0 and 36+6 weeks were included in the study. Blood samples were obtained by venipuncture from the umbilical cord after the delivery of the newborn. The umbilical cord blood IL-6 concentrations were evaluated using ELISA kits. FIRS was defined as umbilical cord blood IL-6>11pg/mL.Women with MIAC and IAI had higher IL-6 concentrations than women without these complications (with MIAC: median 18.1pg/mL versus without MIAC: median 5.8; p<0.0001; with IAI: median 32.9pg/mL, versus without IAI: median 5.8; p<0.0001). Women with IAI with MIAC and women with IAI without MIAC had the highest umbilical cord blood IL-6 concentrations (medians: 32.6 and 39.4pg/mL) and rates of FIRS (78% and 67%).IAI was associated with the highest umbilical cord blood IL-6 concentrations and rate of FIRS independent of the presence or absence of MIAC.
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| 14. |
- Nedopekina, Ekaterina, et al.
(författare)
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Conservative treatment in non-tubal ectopic pregnancy and predictors of treatment failure
- 2021
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Ingår i: European Journal of Obstetrics and Gynecology and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 257, s. 6-10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To find possible predictive factors to predict the failure of conservative treatment of non-tubal ectopic pregnancy. For that purpose, we assessed the rate of failure, complications and need for additional interventions of the different primary treatment regimens in non-tubal ectopic pregnancies that occurred in our center. Study design: Retrospective single-center study conducted at Hospital Clínic of Barcelona (Spain). Conservative treatment regimens included medical (systemic single or multiple dose methotrexate; ultrasound-guided intrasaccular injection of methotrexate or chloride potassium; surgical (oophorectomy in case of ovarian ectopic pregnancy, surgical curettage). The main outcome measures were success of primary treatment and the need for additional interventions. The secondary outcomes were success rate of conservative treatment, incidence of complications, days to discharge from the hospital, days until negative β-hCG, days until complete resolution of the process. Possible predictor factors for primary treatment failure were assessed. Results: A total of 39 cases were included. Primary treatment was successful in 74 % (29/39). The rate of failure of primary treatment was higher in the group with presence of embryo heartbeat than in the group without, 46 % vs. 15 % respectively (p < 0.0001). Among the cases that required additional treatments, none of them required hysterectomy. Presence of embryo heartbeat significantly increased the likelihood of failure of the primary treatment (OR 4.71, 95 % CI 1.03–21.65, p < 0.05). Every doubling of the β-hCG levels increased the risk of treatment failure by 54 % (OR 1.54, 95 % CI 1.03–2.39, p < 0.05). Conclusions: Conservative treatment is a safe option for treatment of non-tubal ectopic pregnancy. The presence of embryo heartbeat and β-hCG levels at diagnosis may be used as predictive factors of failure of conservative treatment.
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| 15. |
- Palacio, Montse, et al.
(författare)
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Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study.
- 2017
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Ingår i: American journal of obstetrics and gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 217:2
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Tidskriftsartikel (refereegranskat)abstract
- Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure limits the use of fetal lung maturity assessment.The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries.This was a prospective multicenter study in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks' gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated.A total of 883 images were collected, but 17.2% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, and positive and negative predictive value of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively.The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.
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| 16. |
- Rodríguez-Trujillo, Adriano, et al.
(författare)
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Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes.
- 2016
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 95:8, s. 926-33
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate, in women with preterm prelabor rupture of membranes (PPROM), the impact on short-term neonatal outcome of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and the microorganisms isolated in women with MIAC, when gestational age is taken into account.Prospective cohort study. We included women with PPROM (22.0-34.0 weeks of gestation) with available information about MIAC, IAI and short-term neonatal outcome. MIAC was defined as positive aerobic/anaerobic/genital Mycoplasma culture in amniotic fluid. Definition of IAI was based on interleukin-6 levels in amniotic fluid. Main outcome measures were Apgar score <7 at 5 min, umbilical artery pH ≤7.0, days in the neonatal intensive care unit, and composite neonatal morbidity, including any of the following: intraventricular hemorrhage grade III-IV, respiratory distress syndrome, early-onset neonatal sepsis, periventricular leukomalacia, necrotizing enterocolitis, and fetal or neonatal death. Labor was induced after 32.0 weeks if lung maturity was confirmed; and otherwise after 34.0 weeks.MIAC and IAI were found in 38% (72/190) and 67% (111/165), respectively. After adjustment for gestational age at delivery, no differences in short-term neonatal outcome were found between women with either MIAC or IAI, compared with the non-infection/non-inflammation ("No-MIAC/No-IAI") group. Furthermore, short-term neonatal outcome did not differ between the MIAC caused by Ureaplasma spp. group, the MIAC caused by other microorganisms group and the "No-MIAC/No-IAI" group.Gestational age at delivery seems to be more important for short-term neonatal outcome than MIAC or IAI in PPROM.
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| 17. |
- Stepan, M., et al.
(författare)
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Maternal Serum C-Reactive Protein in Women with Preterm Prelabor Rupture of Membranes
- 2016
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective This study evaluated maternal C-reactive protein (CRP) as a predictor of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with pre-term prelabor rupture of the membranes (PPROM) before and after 32 weeks of gestation. This study was a prospective observational cohort study of 386 women. Maternal serum CRP concentrations were evaluated, and amniotic fluid samples were obtained via transabdominal amniocentesis at the time of admission. Placentas underwent histopathological examination after delivery. MIAC was defined based on a positive PCR for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive 16S rRNA gene amplification. HCA was defined based on the Salafia classification. Maternal CRP was significantly higher in women with MIAC and HCA (median 9.0 mg/l) than in women with HCA alone (median 6.9 mg/l), MIAC alone (median 7.4 mg/l) and without MIAC or HCA (median 4.5 mg/l) (p<0.0001). CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation. Only the 95th percentile of CRP and PPROM before 32 weeks exhibited a false-positive rate of 1%, a positive predictive value of 90% and a positive likelihood ratio of 13.2 to predict MIAC and HCA. However, the low sensitivity of 15% limits the clinical utility of this detection. CRP is a poor predictor of the occurrence of MIAC and HCA, even at early gestational ages.
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| 18. |
- Stepan, Martin, et al.
(författare)
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Neonatal outcomes in subgroups of women with preterm prelabor rupture of membranes before 34 weeks.
- 2016
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954. ; 29:14
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the influence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) on short-term neonatal outcome in women with preterm prelabor rupture of membranes before 34 weeks of gestation.
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| 19. |
- Svenvik, Maria, 1973-
(författare)
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Prediction of Spontaneous Preterm Birth : Clinical and Immunological Aspects
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Preterm birth (PTB), defined as birth before 37 weeks of gestation, accounts for most neonatal death and morbidity. Accurate prediction is a pre-requisite for the prevention and proper management of PTB. However, methods for prediction are unsatisfactory, although sonographic cervical length has a moderate predictive value. For clinical utility, adding a biomarker could increase the predictive accuracy. The immune system has an important regulatory role during pregnancy. Thus, presumptive predictive biomarkers may be searched for among immune-related molecules, such as cytokines, chemokines and other inflammation-associated mediators. The aims of this thesis were to identify clinical risk factors and immunological prediction markers for PTB, both in women at increased risk of PTB because of preterm labour (PTL) or preterm prelabour rupture of the membranes (PPROM), and in asymptomatic women in early pregnancy. An additional aim was to explore immune reaction patterns in PTL and PPROM compared to normal pregnancy. Material and methods: In a retrospective registry study, including 20,643 women who delivered during a five-year period, risk factors for Apgar score <7 at five minutes and risk factors for PTB <32 weeks were investigated using univariate and multivariate logistic regression. Furthermore, in a multi-centre mixed case-control and prospective cohort study of women with PTL <34 weeks of gestation (n=80), PPROM (n=40), as well as antenatal controls (n=44) and controls in labour at term (n=40), plasma levels of cytokines and chemokines representing different types of immune responses were analysed with a multiplex bead assay. In addition, an extended protein analysis exploring 92 inflammation-associated plasma proteins using proximity extension assay (PEA) was performed, as well as analysis of 67 different oxylipins by liquid chromatography coupled to tandem mass spectrometry. Finally, the PEA technique was used also to explore plasma proteins in a case-control study including 46 women with PTB and 46 women with normal pregnancies and delivery at term. Results and conclusions: A number of partly preventable clinical risk factors for PTB <32 weeks were identified, for example smoking (odds ratio (OR) 1.61 (95% confidence interval (CI) 1.07-2.41)); preeclampsia (OR 5.48 (95% CI 3.39-8.86)); and multiple gestation (OR 15 (95% CI 10-24)). The most evident risk factor for low Apgar scores was PTB; the more preterm the higher the risk. This provides important information for health care professionals, and offers motivations for preventive strategies regarding smoking cessation. Both PTL and PPROM were associated with a more pro-inflammatory profile compared to antenatal controls, with an increase in CXCL1. In addition, PTL showed higher CCL17 levels, and PPROM showed higher IL-6 levels compared with normal pregnancy. The inflammatory profile was even higher in labour at term, reflected by higher levels of CXCL1, CXCL8, and IL-6 compared with PTL, probably due to the more advanced stage of the parturition process in these women. To identify women with PTL and subsequent PTB <34 weeks of gestation, we found that a combination of the proteins IL-6, IL-17C, IL-10RB, and FGF-23 strongly correlated with PTB <34 weeks with an area under the curve (AUC) of 0.90; inferring a sensitivity of 90%, and specificity of 74%. For the prediction of delivery within 48 hours in women with PTL, the combination of IL-6 and IL-17C displayed an AUC of 0.88, with a sensitivity of 100%, and a specificity of 71%. Additionally, plasma levels of oxylipins were associated with time of birth. Lower levels of 9,10-DiHODE were associated with PTB <34 weeks (adjusted (a) OR 0.12 (0.024-0.62)) and with delivery within 48 hours (aOR 0.13 (0.019-0.93)), while higher levels of 11,12-DiHETre were associated with delivery <34 weeks (aOR 6.19 (1.17-32.7)) and higher levels of 8-HETE were associated with delivery within 48 hours (aOR 5.01 (1.13-22.14)). In asymptomatic women, plasma levels of combinations of inflammation-associated proteins in the first and the second trimester also revealed predictive information regarding subsequent risk for PTB <34 weeks. Combining MMP10trim1, sCD40trim2, MCSFtrim2, Flt3Ltrim2, and FGF-21diff (diff= difference in protein levels comparing the first and second trimesters) provided a prediction model with an AUC of 0.90. Proteins from the first trimester exclusively (sCD40 and MMP10) rendered an AUC of 0.76. This work provides valuable knowledge in the field of PTB and PTL with useful information on risk factors for PTB. Important associations between levels of inflammation-associated proteins and oxylipins with PTB following PTL were found. Before these findings can have clinical implications, they need to be validated in other cohorts. Additionally, in order to be clinically useful as a prediction tool for PTB, a bedside test is needed. Since the PEA technique is PCR-based, this might be achievable. For prediction of PTB in early pregnancy, we have interesting findings with acceptable accuracy based on samples from both the first and the second trimesters. However, as preventive interventions for PTB are preferably initiated early in pregnancy, a prediction tool has better value if it is based on plasma samples from the first trimester. Therefore, we plan to extend this study and evaluate other potential protein biomarkers.
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| 20. |
- Tsiartas, Panos, et al.
(författare)
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The association between histological chorioamnionitis, funisitis and neonatal outcome in women with preterm prelabor rupture of membranes.
- 2013
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954. ; 26:13, s. 1332-1336
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To determine the impact of histological chorioamnionitis (HCA) and funisitis on neonatal outcome in preterm prelabor rupture of membranes (PPROM) pregnancies. Methods: Women with PPROM between 24+0 to 36+6 weeks of gestation, admitted to the Department of Obstetrics and Gynecology at the University Hospital Hradec Kralove in the Czech Republic, between July 2008 and October 2010, were enrolled in the study (n=231). Results: The incidence of early-onset sepsis (EOS) differed significantly in neonates born to women with and without HCA, after adjustment for gestational age (11% versus 1%, p=0.011). The incidence of EOS in neonates was also significantly different, after adjustment for gestational age, in cases with and without funisitis (18% versus 4%, p=0.002). The same was also found for retinopathy of prematurity (ROP) cases with and without funisitis (23% versus 4%, p=0.014), after adjustment for gestational age. Conclusions: HCA and funisitis increase the risk of adverse perinatal outcome in PPROM pregnancies.
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| 21. |
- Viklund, Felicia, et al.
(författare)
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Protein Concentrations of Thrombospondin-1, MIP-1β, and S100A8 Suggest the Reflection of a Pregnancy Clock in Mid-Trimester Amniotic Fluid
- 2020
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Ingår i: Reproductive Sciences. - : Springer Science and Business Media LLC. - 1933-7205 .- 1933-7191. ; 27:12, s. 2146-2157
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Tidskriftsartikel (refereegranskat)abstract
- The development of immunoassays enables more sophisticated studies of the associations between protein concentrations and pregnancy outcomes, allowing early biomarker identification that can improve neonatal outcomes. The aim of this study was to explore associations between selected mid-trimester amniotic fluid proteins and (1) overall gestational duration and (2) spontaneous preterm delivery. A prospective cohort study, including women undergoing mid-trimester transabdominal genetic amniocentesis, was performed in Gothenburg, Sweden, 2008–2016 (n = 1072). A panel of 27 proteins related to inflammation was analyzed using Meso-Scale multiplex technology. Concentrations were adjusted for gestational age at sampling, experimental factors, year of sampling, and covariates (maternal age at sampling, parity (nulliparous/multiparous), smoking at first prenatal visit, and in vitro fertilization). Cox regression analysis of the entire cohort was performed to explore possible associations between protein concentrations and gestational duration. This was followed by Cox regression analysis censored at 259 days or longer, to investigate whether associations were detectable in women with spontaneous preterm delivery (n = 47). Finally, linear regression models were performed to analyze associations between protein concentrations and gestational duration in women with spontaneous onset of labor at term (n = 784). HMG-1, IGFBP-1, IL-18, MIP-1α, MIP-1β, S100A8, and thrombospondin-1 were significantly associated with gestational duration at term, but not preterm. Increased concentrations of thrombospondin-1, MIP-1β, and S100A8, respectively, were significantly associated with decreased gestational duration after the Holm-Bonferroni correction in women with spontaneous onset of labor at term. This adds to the concept of a pregnancy clock, where our findings suggest that such a clock is also reflected in the amniotic fluid at early mid-trimester, but further research is needed to confirm this.
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