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. 2012 Feb;206(2):145.e1-9.
doi: 10.1016/j.ajog.2011.08.028. Epub 2011 Sep 8.

The antibiotic treatment of PPROM study: systemic maternal and fetal markers and perinatal outcomes

Brian M Mercer  1 , Dennis T Crouse, Robert L Goldenberg, Menachem Miodovnik, Delicia C Mapp, Paul J Meis, Mitchell P Dombrowski; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Collaborators, Affiliations

The antibiotic treatment of PPROM study: systemic maternal and fetal markers and perinatal outcomes

Brian M Mercer et al. Am J Obstet Gynecol. 2012 Feb.

Abstract

Objective: We sought to correlate maternal and cord blood cytokine and intercellular adhesion molecule-1 levels with antibiotic exposure and perinatal outcomes after conservatively managed preterm premature rupture of the membranes.

Study design: Conservatively managed women with preterm premature rupture of the membranes at 24-32 weeks had blood sampling at randomization (n = 222) and delivery (n = 121). Plasma from these, and umbilical cord blood (n = 196), was stored at -70°C. Interleukin (IL)-6, IL-10, granulocyte colony-stimulating factor (G-CSF), tumor necrosis factor-α, and intercellular adhesion molecule-1 levels were assessed for associations with antibiotic treatment, latency, amnionitis, neonatal sepsis, pneumonia, and composite neonatal morbidity.

Results: Cord blood IL-6 and G-CSF were higher than maternal levels. Antibiotic treatment lowered only maternal G-CSF (P = .01). Elevated maternal cytokine levels were associated with delivery within 7 days and with development of chorioamnionitis. All umbilical cord blood markers were increased with amnionitis (P ≤ .01 for each). No maternal marker was associated with neonatal morbidities. Cord G-CSF and IL-6 were increased with neonatal sepsis within 72 hours of birth (P = .004 for both), and with composite neonatal morbidity (P = .001 and .002, respectively). Maternal and umbilical cord cytokine levels demonstrated low predictive values for perinatal outcomes.

Conclusion: Umbilical cord blood cytokine values are higher than maternal levels, suggesting significant fetal/placental contribution. Maternal and umbilical cord cytokine levels are not adequately predictive to be used clinically.

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Figures

Figure 1
Figure 1
Flow diagram of patient recruitment and specimen collection for this biologic fluids ancillary study.
Figure 2
Figure 2
Receiver operator characteristic curves for selected outcomes according to cytokine levels from maternal blood at randomization (2a) and umbilical cord blood (2b, 2c) among conservatively managed women with PROM before 32 weeks gestation.
Figure 2
Figure 2
Receiver operator characteristic curves for selected outcomes according to cytokine levels from maternal blood at randomization (2a) and umbilical cord blood (2b, 2c) among conservatively managed women with PROM before 32 weeks gestation.
Figure 2
Figure 2
Receiver operator characteristic curves for selected outcomes according to cytokine levels from maternal blood at randomization (2a) and umbilical cord blood (2b, 2c) among conservatively managed women with PROM before 32 weeks gestation.
See this image and copyright information in PMC

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