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Clinical chorioamnionitis at term IV: the maternal plasma cytokine profile.
- Source :
- Journal of Perinatal Medicine; Jan2016, Vol. 44 Issue 1, p77-98, 22p, 3 Charts, 3 Graphs
- Publication Year :
- 2016
-
Abstract
- Introduction: Fever is a major criterion for clinical chorioamnionitis; yet, many patients with intrapartum fever do not have demonstrable intra-amniotic infection. Some cytokines, such as interleukin (IL)-1, IL-6, interferon-gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α), can induce a fever. The objective of this study was to determine whether maternal plasma concentrations of cytokines could be of value in the identification of patients with the diagnosis of clinical chorioamnionitis at term who have microbial-associated intra-amniotic inflammation. Methods: A retrospective cross-sectional study was conducted, including patients with clinical chorioamnionitis at term (n=41; cases) and women in spontaneous labor at term without clinical chorioamnionitis (n=77; controls). Women with clinical chorioamnionitis were classified into three groups according to the results of amniotic fluid culture, broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS), and amniotic fluid IL-6 concentration: 1) no intra-amniotic inflammation; 2) intra-amniotic inflammation without detectable microorganisms; or 3) microbial-associated intra-amniotic inflammation. The maternal plasma concentrations of 29 cytokines were determined with sensitive and specific V-PLEX immunoassays. Nonparametric statistical methods were used for analysis, adjusting for a false discovery rate of 5%. Results: 1) The maternal plasma concentrations of pyrogenic cytokines (IL-1β, IL-2, IL-6, IFN-γ, and TNF-α) were significantly higher in patients with clinical chorioamnionitis at term than in those with spontaneous term labor without clinical chorioamnionitis; 2) the maternal plasma concentrations of cytokines were not significantly different among the three subgroups of patients with clinical chorioamnionitis (intra-amniotic inflammation with and without detectable bacteria and those without intra-amniotic inflammation); and 3) among women with the diagnosis of clinical chorioamnionitis, but without evidence of intra-amniotic inflammation, the maternal plasma concentrations of pyrogenic cytokines were significantly higher than in patients with spontaneous labor at term. These observations suggest that a fever can be mediated by increased circulating concentrations of these cytokines, despite the absence of a local intra-amniotic inflammatory response. Conclusions: 1) The maternal plasma concentrations of pyrogenic cytokines (e.g. IL-1β, IL-2, IL-6, IFN-γ, and TNF-α) are higher in patients with intra-partum fever and the diagnosis of clinical chorioamnionitis at term than in those in spontaneous labor at term without a fever; and 2) maternal plasma cytokine concentrations have limited value in the identification of patients with bacteria in the amniotic cavity. Accurate assessment of the presence of intra-amniotic infection requires amniotic fluid analysis. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACADEMIC medical centers
CHI-squared test
CYTOKINES
ENZYME-linked immunosorbent assay
FETAL diseases
FISHER exact test
GOODNESS-of-fit tests
INTERFERONS
INTERLEUKINS
MEDICAL cooperation
RESEARCH
TUMOR necrosis factors
CROSS-sectional method
RETROSPECTIVE studies
CASE-control method
DATA analysis software
DESCRIPTIVE statistics
MANN Whitney U Test
KRUSKAL-Wallis Test
PREGNANCY
Subjects
Details
- Language :
- English
- ISSN :
- 03005577
- Volume :
- 44
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Journal of Perinatal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 112332932
- Full Text :
- https://doi.org/10.1515/jpm-2015-0103