Applying Maternal Serum and Amniotic Fluid CRP Concentrations, and Cervical Length to Predict Preterm Delivery
,
Abstract
Objective: To investigate the clinical advantage of several prognostic factors for predicting preterm delivery.
Materials and methods: Eighty and six patients with a singleton pregnancy admitted to Vali-Asr hospital underwent genetic amniocentesis between the 15th and 23th weeks were included in this study. Maternal serum C-reactive protein (CRP), transvaginal sonographic measurement of cervical length (CL),were examined on genetic amniocentesis time. Receiver-operating characteristic (ROC) analysis was performed to determine the efficacy of maternal serum and amniotic fluid CRP levels in predicting women with preterm delivery. Correlation between each factor and the duration of pregnancy was investigated.
Results: The prevalence of spontaneous preterm delivery before 37 weeks of gestation was 11%. ROC analysis revealed that maternal serum CRP level was the parameter, which had a significant power in the prediction of preterm delivery. The optimum cut-off level was 1.2 mg/L. The sensitivity and specificity were 95.1% and 91.8%, respectively. The positive predictive value for CL length with the cut off value of 25 mm was 72.1%. No statistically significant difference correlation observed between CL and the duration of pregnancy or amniotic fluid and maternal serum CRP levels.
Conclusion: The maternal serum CRP level has a good sensitivity and specificity in the prediction of preterm delivery and this may be helpful in predicting preterm delivery during genetic amniocentesis. Maternal serum CRP measurement is a safe, simple clinically useful, cost effective, non invasive method, that may assist clinicians in evaluation for high-risk patients and determine strategies for the prevention of preterm delivery.
Arias F, Tomich P. Etiology and outcome of low birth weight and preterm infants. Obstet Gynecol1982; 60: 277–81.
Berkowitz GS, Papienik E. Epidemiology of preterm birth. Epidemiol Rev 1993;15:414-43.
Joseph KS, Kramer MS, Marcoux S, Ohlsson A, Wen SW, Allen A, Et al.
Determinants of preterm birth rates in Canada from 1981 through 1983 and from1992 through 1994. N Engl J Med 1998;339:1434-9.
Gomez R, Ghezzi F, Romero R, Muñoz H, Tolosa JE,Rojas I. Premature labor and intra-amniotic infection.Clinical aspects and role of the cytokines in diagnosis and pathophysiology. Clin Perinatol 1995; 22:281-342.
Edwin SS, Romero R, Rathnasabapathy CM, Athaydel N,Armant DR, Subramanian MG. Protein kinase c stimulates release of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 by human decidual cells. J Matern Fetal Neonatal Med 2002; 12:231–6.
Kluft C, de Maat MP. Sensitive markers of inflammation make it possible to
study the chronic process: the rise of interest in low levels of C-reactive protein. Vascul Pharmacol 2002;39:99-104.
McCaul JF 4th, Rogers LW, Perry KG Jr, Martin RW, Allbert JR, Morrison JC. Premature rupture of membranes at term with an unfavorable cervix: comparison of expectant management, vaginal prostaglandin, and oxytocin induction. South Med J.1997;90:1229-33
Stringer M, Miesnik SR, Brown I, Martz AH, Macones G. Nursing care of the patient with preterm premature rupture of membranes. MCN Am J Matern Child Nurs 2004; 29: 144–50.
Fortunato SJ, Menon R, Lombardi SJ. Role of tumor necrosis factor alpha in the premature rupture of membranes and preterm labor pathways. Am J Obstet Gynecol 2002; 187: 1159–62.
Köszegi T. Immunoluminometric detection of human procalcitonin. J Biochem Biophys Methods 2002; 53:157–64.
Castell JV, Gomez-Lechon MJ, David M, Fabra R, Trullenque R, Heinrich PC. Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology 1990; 12:1179–86.
Yap SH, Moshage HJ, Hazenberg BP, Roelofs HM, Bijzet J, Limburg PC, et al. Tumor necrosis factor (TNF) inhibits interleukin (IL)-1 and/or IL-6 stimulated synthesis of C-reactive protein (CRP) and serum amyloid A (SAA) in primary cultures of human hepatocytes. Biochim Biophys Acta 1991; 1091:405–8.
Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol 1999; 180:499–506.
Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999; 19:972-8.
Ghezzi F, Franchi M, Raio L, Di Naro E, Bossi G, D'Eril GV, et al. Elevated amniotic fluid C-reactive protein at the time of genetic amniocentesis is a marker for preterm delivery. Am J Obstet Gynecol 2002;186:268–73.
Ozer KT, Kavak ZN, Gökaslan H, Elter K, Pekin T. Predictive power of maternal serum and amniotic fluid CRP and PAPP-A concentrations at the time of genetic amniocentesis for the preterm delivery. Eur J Obstet Gynecol Reprod Biol 2005; 122:187-90.
Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, Et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 1996; 334:567-72.
Heath VC, Southall TR, Souka AP, Elisseou A, Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol 1998; 12:312-7.
Crane JM, Van den Hof MC, Armson BA, Liston R.Transvaginal ultrasound in the prediction of preterm delivery: singleton and twin gestations. Obstet Gynecol 1997; 90:357-63.
| Files | ||
| Issue | Vol 7, No 1 (March 2013) | |
| Section | Original Articles | |
| Keywords | ||
| Amniotic Fluid C-Reactive Protein Cervical Length Preterm Delivery | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
