To evaluate the effect of histological chorioamnionitis (HCA) with a negative amniotic fluid (AF) culture on adverse pregnancy and neonatal outcomes and inflammatory status in the AF compartment in women with preterm labor or preterm premature rupture of membranes (PPROM).This is a retrospective cohort study of 153 women diagnosed as having a preterm labor or PPROM (20-34 weeks) who delivered singleton gestations within 48 hours of amniocentesis. AF obtained through amniocentesis was cultured, and interleukin (IL)-6, IL-8, and metalloproteinase-9 (MMP-9) levels were determined. The placentas were examined histologically.The prevalence of HCA with negative AF culture was 23.5% (36/153). The women with HCA but with a negative AF culture (group 2) and those with a positive AF culture (group 3) had a significantly lower mean gestational age at amniocentesis and delivery than those with a negative AF culture and without HCA (group 1). Women in group 3 had the highest levels of AF IL-6, IL-8, and MMP-9, followed by those in group 2, and those in group 1. Composite neonatal morbidity was significantly higher in groups 2 and 3 than in group 1, but this was no longer significant after adjusting for confounders caused mainly by the impact of gestational age.In the women who delivered preterm neonates, HCA with a negative AF culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, and prematurity-associated composite neonatal morbidity, and its risks are similar to the risk posed by positive AF culture.
Abstract Aims To develop a model based on clinical and ultrasound parameters to predict the risk of cesarean delivery after labor induction in near‐term twin gestations. Methods This retrospective cohort study included 189 consecutive women with twin gestations at ≥ 36.0 weeks scheduled for labor induction. The Bishop score and transvaginal ultrasonographic measurements of cervical length were obtained immediately before labor induction. Parameters studied included maternal age, height, weight, parity, gestational age, Bishop score, cervical length, epidural analgesia, method of conception, chorionicity and birth weight. Prostaglandin E 2 (dinoprostone) and oxytocin were used for labor induction. Logistic regression analysis and receiver operating characteristic curve were used to generate a predictive model for cesarean delivery. Results Fifty (26.5%) of the 189 women had cesarean deliveries. According to logistic regression analysis, maternal height ( P = 0.004), parity ( P = 0.005) and cervical length ( P = 0.016), but not Bishop score ( P = 0.920 ), were identified as independent predictors of cesarean delivery. A risk score based on a model of these three parameters was calculated for each patient. The model was shown to have an adequate goodness of fit ( P = 0.201 ) and the area under the curve was 0.722 , indicating fairly good discrimination. Conclusions Maternal height, parity and cervical length were independent parameters for predicting the risk of cesarean delivery after labor induction in twin gestations. A predictive model using these parameters may provide useful information for deciding whether or not to induce labor.
Objective: Acute funisitis is a histologic hallmark of the fetal inflammatory response syndrome. This study was conducted to examine the hematologic profiles of preterm newborns with funisitis.Methods: The hematologic profiles of umbilical cord blood obtained at birth were compared according to the presence or absence of acute funisitis in 197 preterm neonates (gestational age before 34 weeks) born to mothers with preterm labor with intact membranes or premature rupture of membranes.Results: (1) Funisitis was identified in 22.3% (44/197) of patients; (2) newborns with funisitis had higher median leukocyte, neutrophil, monocyte counts (p < 0.005 for each), higher rate of neutrophilia (p < 0.05), higher proportion of neutrophils among leukocytes and lower proportion of lymphocytes among leukocytes than those without funisitis (p < 0.01 for each); (3) newborns with funisitis had a significantly lower median RBC count, hemoglobin concentration and hematocrit than those without funisitis (p < 0.05 for each); (4) there was no significant difference in the median lymphocyte, eosinophil, basophil, NRBC and platelet counts between the two groups (p > 0.1 for each).Conclusions: The hematologic profiles of preterm newborns with funisitis are characterized by increased total white blood cell, neutrophil, and monocyte counts and decreased RBC count and hemoglobin concentration.
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