Klinički značaj intraamnijalne inflamacije kod prevremenih porođaja
The clinical significance of intra-amniotic inflammation in preterm births
AuthorTasić, Marija S.
Committee membersPopović, Jasmina
Janošević Radović, Dragana
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OBJECTIVE: The aim of this study was to determine the frequency, clinical characteristics and significance of intra-amniotic inflammation in patients with preterm labour. SUBJECTS AND METHODS: The study was conducted as a prospective, randomized study. The patients were divided into 2 groups. The examined group consisted of patients with singleton pregnancies and a diagnosis of preterm labor (PTL). The control group consisted of patients with singleton pregnancies delivered at term. Comparison of numerical and descriptive characteristics of the respondents was conducted between the experimental and control group, as well as among members of the examined group compared to the presence of abnormal colonization of the lower genital tract, the level of IL -6 in the amniotic fluid and placenta and fetal membranes pathological findings. Amniotic fluid samples were taken through a transabdominal amniocentesis, centrifuged, and were frozen at -70 ° C. The concentration of interleukin-6 was mea...sured by a colorimetric high-sensitive ELISA test (R&D Systems) with a sensitivity of < 1pg/ml . Frequency of certain categories of descriptive characteristics between groups were compared by χ2 test or Fisher 's test. Comparison of numerical values of characteristics between the examined and control group was performed by Student's t-test or Mann-Whitney U test when not fulfilled the requirement of normality schedule. Comparison of numerical values between the three groups of subjects performed a one-sided analysis of variance (one- way ANOVA) and Tukey post-hoc test. Probability level of 5 % ( p < 0.05 ) is taken as the limit level of statistical significance. RESULTS: Pregnant women in whom preterm delivery had occurred, more frequently had burdened life history of desease and obstetric history. As well as the abnormal colonization of the lower genital tract is significantly more frequent finding in the examined group, it was also the presence of clinical chorioamnionitis, especially in cases with elevated amniotic fluid levels of IL-6. There is a frequent association of clinical and histological chorioamnionitis in the group of preterm labour. Preterm Premature Rupture of Membranes (PPROM) is significantly more frequent in the examined group as well as the elevated values of uterine artery RI. PPROM was significantly more often present in case of inflammatory changes in the placenta and fetal membranes (chorioamnionitis). IUGR and a high uterine artery RI are more often associated with pathological findings of placental vascular lesions. The majority of deliveries were completed vaginally in both groups, but the perinatal outcome (Ap score) was significantly worse in the group with PTL. AP score of 0-7 was more frequent in the group of preterm deliveries with elevated levels of amniotic fluid IL-6. As well as the onset of neuromorbidity, the overall neonatal morbidity was also more common in examined group. The histopathological findings with the presence of inflammation and vascular lesions were significantly more frequent in the experimental group, especially in cases of abnormal genital tract colonization. Perinatal mortality was significantly higher in the experimental group. Total perinatal mortality of the experimental group was significantly higher in the case of elevated levels of IL- 6 in the amniotic fluid. CONCLUSION: Preterm labor is a complex clinical syndrome, and intrauterine inflammation plays an important role in its etiopathogenesis. In cases of PTL, burdened life history is more frequent finding as well as the obstetric history of events that correlate with the process of inflammation (irregularity of menstrual cycles, infertility, previous miscarriages and premature births, bleeding in pregnancy, PIH and pre-eclampsia). Increased levels of IL-6 in the amniotic fluid are often accompanied with PTL and can be a sensitive biochemical marker of intrauterine inflammation and a good predictor of preterm delivery. Basically, fetal/neonatal inflammatory response syndrome can be considered as a crucial event in the high neuro and overall morbidity of preterm neonates. The high overall perinatal mortality in cases with elevated amniotic fluid IL-6 levels in preterm deliveries suggests an association of intra amniotic infection/inflammation and poor perinatal outcome.