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Intra-amniotic Inflammation (intra-amniotic + inflammation)
Selected AbstractsFetal inflammatory response in women with proteomic biomarkers characteristic of intra-amniotic inflammation and preterm birthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2009CS Buhimschi Objective, To determine the relationship between presence of amniotic fluid (AF) biomarkers characteristic of inflammation (defensins 2 and 1 and calgranulins C and A) and fetal inflammatory status at birth. Design, Prospective observational cohort. Setting, Tertiary referral University hospital. Population, One hundred and thirty-two consecutive mothers (gestational age, median [interquartile range]: 29.6 [24.1,33.1] weeks) who had a clinically indicated amniocentesis to rule out infection and their newborns. Methods, Intra-amniotic inflammation was diagnosed by mass spectrometry surface-enhanced-laser-desorption-ionization time of flight (SELDI-TOF). The AF proteomic fingerprint (mass-restricted [MR] score) ranges from 0,4 (none to all biomarkers present). The intensity of intra-amniotic inflammation was graded based on the number of proteomic biomarkers: MR score 0: ,no' inflammation, MR score 1,2: ,minimal' inflammation and MR score 3,4: ,severe' inflammation. At birth, cord blood was obtained for all women. Severity of histological chorioamnionitis and early-onset neonatal sepsis (EONS) was based on established histological and haematological criteria. Interleukin-6 (IL-6) levels were measured by sensitive immunoassays. The cord blood-to-AF IL-6 ratio was used as an indicator of the differential inflammatory response in the fetal versus the AF compartment. Main outcome measures, To relate proteomic biomarkers of intra-amniotic infection to cord blood IL-6 and to use the latter as the primary marker of fetal inflammatory response. Results, Women with intra-amniotic inflammation delivered at an earlier gestational age (analysis of variance, P < 0.001) and had higher AF IL-6 levels (P < 0.001). At birth, neonates of women with severe intra-amniotic inflammation had higher cord blood IL-6 levels (P = 0.002) and a higher frequency of EONS (P = 0.002). EONS was characterised by significantly elevated cord blood IL-6 levels (P < 0.001). Of the 39 neonates delivered by mothers with minimal intra-amniotic inflammation, 15 (39%) neonates had umbilical cord blood IL-6 levels above the mean for the group and 2 neonates had confirmed sepsis. The severity of the neutrophilic infiltrate in the chorionic plate (P < 0.001), choriodecidua (P = 0.002), umbilical cord (P < 0.001) but not in the amnion (P > 0.05) was an independent predictor of the cord blood-to-AF IL-6 ratio. Relationships were maintained following correction for gestational age, birthweight, amniocentesis-to-delivery interval, caesarean delivery, status of the membranes, race, MR score and antibiotics and steroid exposure. Conclusions, We provide evidence that presence of proteomic biomarkers characteristic of inflammation in the AF is associated with an increased inflammatory status of the fetus at birth. Neonates mount an increased inflammatory status and have positive blood cultures even in the context of minimal intra-amniotic inflammation. [source] ORIGINAL ARTICLE: Activation of the Alternative Pathway of Complement is a Feature of Pre-Term Parturition but not of Spontaneous Labor at TermAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2010Edi Vaisbuch Citation Vaisbuch E, Romero R, Erez O, Mazaki-Tovi S, Kusanovic JP, Soto E, Dong Z, Chaiworapongsa T, Kim SK, Ogge G, Pacora P, Yeo L, Hassan SS. Activation of the alternative pathway of complement is a feature of pre-term parturition but not of spontaneous labor at term. Am J Reprod Immunol 2010; 63: 318,330 Problem, Plasma concentrations of fragment Bb (FBb) are a marker for activation of the alternative pathway of the complement system. High concentrations of FBb in maternal blood, as early as the first trimester, are associated with subsequent spontaneous pre-term delivery <34 weeks of gestation. The aim of this study was to determine whether spontaneous pre-term labor (PTL) with intact membranes, intra-amniotic infection/inflammation (IAI) or labor at term are associated with alterations in circulating maternal FBb concentrations. Method of study, This cross-sectional study included women in the following groups: (i) non-pregnant (n = 40); (ii) normal pregnancy (gestational age range 20,36, 6/7 weeks, n = 63); (iii) women at term not in labor (n = 70); (iv) women at term in spontaneous labor (n = 59); (v) patients with an episode of PTL who delivered at term (n = 62); (vi) PTL without IAI who delivered pre-term (n = 30); and (vii) PTL with IAI who delivered pre-term (n = 67). Maternal plasma FBb concentrations were determined by ELISA. Results, (i) Among patients with PTL, those who had a pre-term delivery either with IAI (1.21 ,g/mL, IQR 0.77,2.16) or without IAI (1.13 ,g/mL, IQR 0.92,2.08) had a higher median maternal plasma FBb concentration than those who delivered at term (0.86 ,g/mL, IQR 0.64,1.57; P = 0.007 and P = 0.026, respectively); (ii) there was no difference in the median plasma FBb concentration between patients with and without IAI who delivered pre-term (P = 0.9); (iii) in contrast, spontaneous labor at term was not associated with a significant change in the maternal plasma FBb concentration (P = 0.8); (iv) maternal plasma concentration of FBb did not differ significantly between normal pregnant women and the non-pregnant controls (P = 0.8) and were not correlated with advancing gestational age (r = ,0.28, P = 0.8). Conclusion, (i) Pre-term parturition is associated with activation of the alternative complement pathway in maternal circulation; (ii) such activation is not detectable in spontaneous labor at term; (iii) IAI does not explain the activation of the alternative pathway of complement in PTL. Collectively, these observations suggest that pre-term and term labors have fundamental differences in the regulation of innate immunity. [source] Fetal inflammatory response in women with proteomic biomarkers characteristic of intra-amniotic inflammation and preterm birthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2009CS Buhimschi Objective, To determine the relationship between presence of amniotic fluid (AF) biomarkers characteristic of inflammation (defensins 2 and 1 and calgranulins C and A) and fetal inflammatory status at birth. Design, Prospective observational cohort. Setting, Tertiary referral University hospital. Population, One hundred and thirty-two consecutive mothers (gestational age, median [interquartile range]: 29.6 [24.1,33.1] weeks) who had a clinically indicated amniocentesis to rule out infection and their newborns. Methods, Intra-amniotic inflammation was diagnosed by mass spectrometry surface-enhanced-laser-desorption-ionization time of flight (SELDI-TOF). The AF proteomic fingerprint (mass-restricted [MR] score) ranges from 0,4 (none to all biomarkers present). The intensity of intra-amniotic inflammation was graded based on the number of proteomic biomarkers: MR score 0: ,no' inflammation, MR score 1,2: ,minimal' inflammation and MR score 3,4: ,severe' inflammation. At birth, cord blood was obtained for all women. Severity of histological chorioamnionitis and early-onset neonatal sepsis (EONS) was based on established histological and haematological criteria. Interleukin-6 (IL-6) levels were measured by sensitive immunoassays. The cord blood-to-AF IL-6 ratio was used as an indicator of the differential inflammatory response in the fetal versus the AF compartment. Main outcome measures, To relate proteomic biomarkers of intra-amniotic infection to cord blood IL-6 and to use the latter as the primary marker of fetal inflammatory response. Results, Women with intra-amniotic inflammation delivered at an earlier gestational age (analysis of variance, P < 0.001) and had higher AF IL-6 levels (P < 0.001). At birth, neonates of women with severe intra-amniotic inflammation had higher cord blood IL-6 levels (P = 0.002) and a higher frequency of EONS (P = 0.002). EONS was characterised by significantly elevated cord blood IL-6 levels (P < 0.001). Of the 39 neonates delivered by mothers with minimal intra-amniotic inflammation, 15 (39%) neonates had umbilical cord blood IL-6 levels above the mean for the group and 2 neonates had confirmed sepsis. The severity of the neutrophilic infiltrate in the chorionic plate (P < 0.001), choriodecidua (P = 0.002), umbilical cord (P < 0.001) but not in the amnion (P > 0.05) was an independent predictor of the cord blood-to-AF IL-6 ratio. Relationships were maintained following correction for gestational age, birthweight, amniocentesis-to-delivery interval, caesarean delivery, status of the membranes, race, MR score and antibiotics and steroid exposure. Conclusions, We provide evidence that presence of proteomic biomarkers characteristic of inflammation in the AF is associated with an increased inflammatory status of the fetus at birth. Neonates mount an increased inflammatory status and have positive blood cultures even in the context of minimal intra-amniotic inflammation. [source] |