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KMID : 0606620090050010017
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Korean Journal of Fetal Medicine
2009 Volume.5 No. 1 p.17 ~ p.24
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Interleukin-6 concentrations in trans-vaginal amniotic fluid as a marker for intra-amniotic inflammation in preterm premature rupture of membranes
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Yang Hye-Jin
Kim Sun-Min
Lee Kyung-A
Lee Seung-Mi
Oh Kyung-Joon
Park Chan-Wook
Park Joong-Shin
Jun Jong-Kwan
Syn Hee-Chul
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Abstract
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Objectives: Our purpose was to determine whether Internelukin-6 (IL-6) concentrations in trans-vaginal amniotic
fluid are of value in the identification of intra-amniotic inflammation and in the prediction of significant neonatal morbidity in patients with preterm premature rupture of membranes.
Methods: Trans-abdominal amniocentesis and trans-vaginal amniotic fluid sampling were performed in 79 patients with preterm premature rupture of membranes. Matrix metalloproteinase-8 (MMP-8) in amniotic fluid by trans-abdominal amniocentesis and IL-6 in trans-vaginal amniotic fluid were determined by enzyme-linked immunosorbent assay (ELISA). Intra-amniotic inflammation (IAI) was defined as amniotic fluid MMP-8 concentrations >23 ng/mL. Significant neonatal morbidity was defined as the presence of any of the following conditions: congenital proven or suspected sepsis, respiratory distress syndrome, congenital pneumonia, bronchopulmonary dysplasia, intraventricular hemorrhage and necrotizing enterocolitis. Receiver-operator characteristic curve, Mann-Whitney U test, Fisher’s exact test and survival analysis were used for analysis.
Results: 1) Patients with IAI had significantly higher median IL-6 concentrations in trans-vaginal amniotic fluid than those without IAI (median 576.9 ng/mL, range 28.8 to 985.5 pg/mL vs median 165.1 pg/mL, range 8.4 to 788.2 pg/mL, p<0.001). Patients with trans-vaginal amniotic fluid IL-6 >250 pg/mL had a significantly shorter sampling-to-delivery interval (median (range), 122.5 hours (2.0-2376) vs 136.0 hours (0.1-2989), p=0.04) and higher rates of significant
neonatal morbidity (38.5% vs 15.2%, p=0.026).
Conclusions: An elevated IL-6 in trans-vaginal amniotic fluid is a predictive marker for intra-amniotic inflammation, impending preterm delivery and significant neonatal morbidity.
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KEYWORD
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Trans-vaginal amniotic fluid, Amniocentesis, Interleukin-6, Intra-amniotic inflammation, Neonatal morbidity
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