Am J Perinatol
DOI: 10.1055/a-1673-0280
Original Article

Complement activation fragments in cervicovaginal fluid are associated with intra-amniotic infection/inflammation and spontaneous preterm birth in women with preterm premature rupture of membranes

Complement activation fragments in CVF, IAI and SPTB
Subeen Hong
1  Department of Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Seoul, Korea, Seoul, Korea (the Republic of)
,
Se Jin Lee
2  Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea, Chuncheon, Korea (the Republic of)
,
Yu Mi Kim
3  Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
,
Young Eun Lee
3  Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
,
Yehyon Park
4  Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
,
Hyeon Ji Kim
5  Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
,
Kyo Hoon Park
3  Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Seongnam, Korea (the Republic of)
› Author Affiliations
Supported by: the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) 2020R1F1A1048362

Objective: We sought to determine whether the levels of complement and other inflammatory and angiogenic mediators in cervicovaginal fluid (CVF) are independently associated with intra-amniotic infection and/or inflammation (IAI) and imminent spontaneous preterm birth (SPTB, ≤48 hours of sampling) in women with preterm premature rupture of membranes (PPROM). Study design: This was a retrospective study consisting of 85 singleton pregnant women with PPROM at 20+0 to 33+6 weeks. Amniotic fluid (AF) obtained via amniocentesis was cultured and assayed for interleukin-6. CVF samples collected at the time of amniocentesis were assayed for complement C3a, C4a, and C5a, HSP70, M-CSF, M-CSF-R, S100 A8, S100 A9, thrombospondin-2, VEGF, and VEGFR-1 by ELISA. Results: Multivariate logistic regression analyses revealed that elevated CVF concentrations of complement C3a, 4a and 5a were significantly associated with an increased risk of IAI and imminent SPTB, whereas those of M-CSF were associated with IAI, but not imminent SPTB (P=0.063), after adjustment for baseline covariates (e.g., gestational age at sampling). However, univariate and multivariate analyses showed that the CVF concentrations of angiogenic (thrombospondin-2, VEGF, and VEGFR-1) and inflammatory (HSP70, M-CSF-R, S100 A8, and S100 A9) proteins were not associated with either IAI or imminent SPTB. Conclusions: In women with PPROM, elevated CVF concentrations of complement C3a, C4a, and C5a are independently related to an increased risk of IAI and imminent SPTB. These findings suggest that complement activation in CVF is significantly involved in mechanisms underlying preterm birth and in the host response to IAI in the context of PPROM.



Publication History

Received: 18 December 2020

Accepted after revision: 10 October 2021

Publication Date:
19 October 2021 (online)

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