Shi Nae Kim

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.

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.

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.