Eun Ha Jeong

Noninvasive prediction of intra-amniotic infection and/or inflammation in preterm premature rupture of membranes.

Objective: To develop a model based on noninvasive parameters to predict the probability of intra-amniotic infection and/or inflammation (IAI) in women with preterm premature rupture of membranes (PPROMs). Methods: Maternal blood was collected for determination of the C-reactive protein (CRP) level and white blood cell (WBC) count immediately after amniocentesis in 171 consecutive women with PPROMs. Intra-amniotic infection and/or inflammation was defined as a positive amniotic fluid (AF) culture and/or an elevated AF interleukin 6 level (≥2.6 ng/mL). Results: A risk score based on a model including maternal blood CRP, WBC, parity, and gestational age was calculated for each patient. The model was shown to have an adequate goodness of fit (P = .516), and the area under the receiver–operating characteristic curve was 0.848, indicating very good discrimination. Conclusion: The noninvasive model based on maternal blood CRP, WBC, parity, and gestational age is highly predictive of IAI in women with PPROMs.

Predictive value of combined cervicovaginal cytokines and gestational age at sampling for intra‐amniotic infection in preterm premature rupture of membranes

To determine whether interleukin (IL)‐1β, IL‐6, and IL‐8 in cervicovaginal fluid, alone or in combination with clinical risk factors, could predict intra‐amniotic infection in women with preterm premature rupture of membranes (PPROM).

Intra-Amniotic Infection/Inflammation as a Risk Factor for Subsequent Ruptured Membranes after Clinically Indicated Amniocentesis in Preterm Labor

The aim of this study was to determine whether intra-amniotic infection/inflammation (IAI) was associated with subsequent ruptured membranes in women with preterm labor and intact membranes who had a clinically indicated amniocentesis. This retrospective cohort study included 237 consecutive women with preterm labor (20-34.6 weeks) who underwent amniocentesis. The clinical and laboratory parameters evaluated included demographic variables, gestational age, C-reactive protein (CRP) and amniotic fluid (AF) white blood cell, interleukin-6 (IL-6) and culture results. IAI was defined as a positive AF culture and/or an elevated AF IL-6 level (>2.6 ng/mL). The primary outcome was ruptured membranes in the absence of active labor occurring within 48 hours of amniocentesis. Preterm premature rupture of membranes subsequently developed in 10 (4.2%) women within 48 hr of amniocentesis. Multivariate analysis demonstrated that only IAI was independently associated with the ruptured membranes occurring within 48 hr of amniocentesis. In the predictive model based on variables assessed before amniocentesis, only CRP level was retained. IAI is an independent risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. Prior to amniocentesis, measurement of serum CRP level can provide a risk assessment for the subsequent development of ruptured membranes after the procedure.

Relationship between maternal serum C-reactive protein, funisitis and early-onset neonatal sepsis.

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (≥ 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.

Comparison between sonographic cervical length and Bishop score in preinduction cervical assessment: a randomized trial

To compare sonographically measured cervical length with the Bishop score in determining the requirement for prostaglandin administration for preinduction cervical ripening in nulliparae at term.

Prediction of imminent preterm delivery in women with preterm premature rupture of membranes

Abstract Aims: To develop a model based on non-invasive clinical parameters to predict the probability of imminent preterm delivery (delivery within 48 h) in women with preterm premature rupture of membranes (PPROM), and to determine if additional invasive test results improve the prediction of imminent delivery based on the non-invasive model. Methods: Transvaginal ultrasonographic assessment of cervical length was performed and maternal serum C-reactive protein (CRP) and white blood cell (WBC) count were determined immediately after amniocentesis in 102 consecutive women with PPROM at 23–33+6 weeks. Amniotic fluid (AF) obtained by amniocentesis was cultured and interleukin-6 (IL-6) levels and WBC counts were determined. Results: Serum CRP, cervical length, and gestational age were chosen for the non-invasive model (model 1), which has an area under the curve (AUC) of 0.804. When adding AF IL-6 as an invasive marker to the non-invasive model, serum CRP was excluded from the final model (model 2) as not significant, whereas AF IL-6, cervical length, and gestational age remained in model 2. No significant difference in AUC was found between models 1 and 2. Conclusions: The non-invasive model based on cervical length, gestational age, and serum CRP is highly predictive of imminent delivery in women with PPROM. However, invasive test results did not add predictive information to the non-invasive model in this setting.

Clinical and sonographic parameters at mid‐trimester and the risk of cesarean delivery in low‐risk nulliparas

To examine the potential clinical and sonographic parameters at mid‐trimester that predict the risk of intrapartum cesarean delivery at term among low‐risk nulliparas.

Bishop score and cervical length at 33–35 weeks of gestation and the risk of intrapartum cesarean delivery of twins

Abstract Aim: The aim of this study is to determine the association between Bishop score and cervical length measured at 33–35 weeks of gestation and the intrapartum risk of cesarean delivery of twins. Methods: This prospective observational study recruited women with vertex/vertex twin gestations at 33–35 weeks of gestation. Determination of the Bishop score and ultrasound measurement of the cervical length were performed. A regression model was constructed with control for known intrapartum and postpartum confounders. Results: One hundred and forty-six women were analyzed; 18 women (12.3%) had cesarean deliveries during labor. Based on univariate nalysis, the Bishop score at 33–35 weeks was significantly associated with the risk of intrapartum cesarean delivery of twins, whereas cervical length, maternal age, height, and weight at 33–35 weeks were not associated. Multivariate logistic regression analysis identified induction of labor and birth weight of the first-born twin, but not Bishop score, as independent predictors of intrapartum cesarean delivery of twins. Conclusions: A low Bishop score at 33–35 weeks of gestation was associated with an increased risk of intrapartum cesarean delivery of twin gestations. However, this relationship disappeared after adjusting for relevant intrapartum or postpartum confounders. Only labor induction and high birth weight of the first-born twin were independently associated with an increased risk of cesarean delivery in labor.

The relationship between amniotic fluid white blood cell count and inflammatory lesions of the placenta in women with preterm premature rupture of membranes

목적: 만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수와 태반 염증성 병변의 존재 및 정도와의 관련성을 확인하고자 한다. 연구방법: 만삭 전 조기양막파수로 입원한 단태임신 임신부 중 양수 내 백혈구 수 측정 및 양수 배양검사를 위해 경복부 양수천자가 시행되고, 양수 천자 후 72시간 내에 조기분만(임신 24.0-35.6주 사이)되었으며, 태반의 조직학적 검사가 시행된 90명의 임신부를 대상으로 하였다. 결과: 조직학적 융모양막염의 빈도는 32%였으며 양성 양수 배양인 경우는 21%였다. 태반 염증성 병변이 존재하는 경우는 존재하지 않는 경우에 비하여 양수 내 백혈구 수가 유의하게 많았다. 양수 내 백혈구 수는 교란변수의 영향을 보정한 후에도 태반 염증성 병변의 존재와 유의한 관련성을 나타내었다. 또한 양수 내 백혈구 수는 각각의 태반 부위별 염증 정도가 심할수록 유의하게 증가하였다. 태반 염증성 병변 존재를 가장 잘 예측할 수 있는 양수 백혈구 수의 절단치는 25개/mm3였고 이때 민감도 62%, 특이도 77%를 나타내었다. 결론: 만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수는 태반의 염증성 병변의 존재 및 정도와 유의한 관련성을 가지고 있으며 산전에 이의 존재 유무를 예측할 수 있는 독립적 인자이다.

OP30.05: Clinical and sonographic parameters at mid‐trimester to predict the risk of primary Cesarean delivery in nulliparas

age and low-lying placenta. The timing of trophoblastic invasion, however suggests this condition could be identified in the first trimester of pregnancy. The objective is to describe the relation between the uterine scar and the trophoblast by transvaginal ultrasound (TVUS) as well as the potential predictive value for identifying PA in patients with a history Caesarean section (CS). Methods: All patients with a history of CS underwent TVUS between 11 and 13+6 weeks as part of routine prenatal care. A standard plane was defined as mid-sagittal view through the cervical canal showing the isthmus and the lower part of the gestational sac. The relationship between the scar and the trophoblast led to 2 groups. Group A: trophoblast not overlapping the scar and group B: trophoblast overlapping the scar. All patients were followed until delivery. Results: 123 patients with a at least one prior Caesarean were prospectively included. Median gestational age for ultrasound was 12 weeks (11–13+6). Median maternal age was 33 years (22–45). In one case, the scar was not visualized. Group A comprised 115 patients (94%) and Group B 7 patients (6%). The only case of PA was diagnosed in one patient of group B, as suspected on followup ultrasound. An elective CS and conservative management was initially performed. The placenta was still intrauterine 3 months later, when endometritis developed requiring a hysterectomy. In all other cases, follow-up ultrasound showed normal placental insertion and eventless delivery with respect to PA. Conclusions: TVUS assessment of the uterine scar in relation to the trophoblast during first trimester is promising for early detection of patients at-risk of PA. This finding should help pre-delivery recognition of PA, thus potentially reducing the related maternal morbidity.