Transactions of the Twenty-First Annual Meeting of the Society for Maternal-Fetal Medicine—Continued
Amniotic fluid matrix metalloproteinase–8 in preterm labor with intact membranes

Presented at the Twenty-first Annual Meeting of the Society for Maternal-Fetal Medicine, Reno, Nev, February 5-10, 2001.
https://doi.org/10.1067/mob.2001.118165Get rights and content

Abstract

Objective: Intra-amniotic inflammation is a major determinant of maternal and neonatal outcome in patients with preterm labor. Matrix metalloproteinase–8 is a sensitive marker of inflammation in body fluids. This study was conducted to examine the value of amniotic fluid matrix metalloproteinase–8 determinations in patients with preterm labor and intact membranes. Study Design: Amniotic fluid was obtained by transabdominal amniocentesis from 371 patients with preterm labor. Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Amniotic fluid analysis included Gram stain examination, white blood cell count, and matrix metalloproteinase–8 (enzyme-linked immunosorbent assay) determination. Nonparametric statistics were used for analysis. Results: The rate of preterm delivery was 54% (200/371) and that of intra-amniotic infection was 9.2% (34/371). The median amniotic fluid matrix metalloproteinase–8 concentration was more than 50-fold higher in patients with intra-amniotic infection than in patients with no intra-amniotic infection (median, 605.6 ng/mL; range, 0.65-15,000 ng/mL vs median, 10.6 ng/mL; range, <0.06-16,600 ng/mL, respectively; P <.0001). The matrix metalloproteinase–8 amniotic fluid concentrations were significantly higher in patients who delivered preterm than in patients who delivered at term (median, 19.5 ng/mL; range, <0.06–16,600 ng/mL vs median, 2.1 ng/mL; range, <0.06-500 ng/mL, respectively; P <.001). After exclusion of patients with intra-amniotic infection, patients who delivered preterm had a significantly higher median amniotic fluid matrix metalloproteinase–8 than patients who delivered at term (P <.05). An amniotic fluid matrix metalloproteinase–8 level of >30 ng/mL was an independent predictor for the occurrence of neonatal morbidity (odds ratio, 3.4; 95% CI, 1.9-5.8; P <.01). Conclusion: Increased amniotic fluid matrix metalloproteinase–8 concentrations identify patients at risk for intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome. (Am J Obstet Gynecol 2001;185:1149-55.)

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Material and methods

Women who were admitted to Hutzel Hospital from July 1992 to December 1996 with preterm labor and intact membranes were offered an amniocentesis for the diagnosis of IAI and the assessment of fetal lung maturity. Those patients who consented to have an amniocentesis were asked to donate additional amniotic fluid for research purposes. Eligibility criteria for this study included (1) preterm labor with intact membranes, (2) singleton gestation, (3) consent for an amniocentesis, and (4) written

Results

Three hundred seventy-one patients were included in this study. MMP-8 amniotic fluid concentrations were above the assay sensitivity in 88.4% of all samples (328/371).

Overall, IAI was present in 9.2% of patients (34/371). MMP-8 was detectable in all patients with IAI. The rate of preterm delivery in this patient population was 54% (200/371). The most common microbial isolates were Ureaplasma urealyticum (Table I).

. Microorganisms isolated from amniotic fluid of patients with preterm labor

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Comment

Our data indicate that amniotic fluid MMP-8 concentration identifies patients who are at risk for IAI, impending preterm delivery, and adverse neonatal outcome. MMP-8 was better in the detection of a positive amniotic fluid culture than IL-6 or amniotic fluid white blood cell count and Gram stain. Moreover, MMP-8 had a higher sensitivity for the detection of positive amniotic fluid culture than the combination of Gram stain and amniotic fluid white blood cell count (82.4% vs 60%). However, a

Acknowledgements

The authors wish to acknowledge the contributions of Dr Moshe Mazor, Dr Stanley Berry, Dr Yoram Sorokin, Dr Sonia Hassan, Dr Sean Blackwell, Dr Robert Sokol, Dr Mark Evans, and Dr Mitchell Dombrowski, as well as those of Mr Michael Kruger, Biostatistician at C. S. Mott Center, Wayne State University; the nursing staff of the Detroit Medical Center: Ms Sandy Field, Ms Vicki Ineson, Ms Penny Clinansmith, Ms Mabubeh Mahoudieh, Ms Cindy Urbanik, Ms Jean Thayer-Seitz, Ms Audrey Miliken, Ms Leandra

References (23)

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Reprint requests: Roberto Romero, MD, Perinatology Research Branch, NICHD, Wayne State University/Hutzel Hospital, Department of Obstetrics and Gynecology, 4707 St Antoine Blvd, Detroit, MI 48201. E-mail: [email protected].

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