Abstract
Objective The purpose of this study was to evaluate the predictive value of vaginal fluid biomarkers
for chorioamnionitis and adverse perinatal outcomes in women with preterm premature
rupture of membranes (PPROM).
Methods We recruited women with PPROM, without clinical chorioamnionitis, between 22 and
36 weeks' gestation. Vaginal fluid was collected on admission for the measurement
of metalloproteinase-8 (MMP-8), interleukin-6 (IL-6), lactate, and glucose concentration.
Placental pathology and neonatal charts were reviewed. Primary outcomes were histological
chorioamnionitis and adverse neonatal neurological outcomes (intraventricular hemorrhage
grade 2 or 3, periventricular leukomalacia, or hypoxic/ischemic encephalopathy). Linear
regression analyses were used to adjust for gestational age at PPROM.
Results Twenty-seven women were recruited at a mean gestational age of 31.6 ± 3.1 weeks,
including 25 (93%) with successful collection of vaginal fluid sample. Histological
chorioamnionitis and adverse neonatal neurological outcomes were observed in nine
(33%) and four (15%) cases, respectively. In univariate analysis, MMP-8, IL-6, glucose,
and lactate concentrations in vaginal fluid were associated with the risk of chorioamnionitis
but not anymore after adjustment for gestational age at PPROM. MMP-8 concentration
was the only biomarker associated with adverse neurological outcome, and it remained
significant after adjustment for gestational age at PPROM (p = 0.02).
Conclusion Vaginal fluid inflammatory biomarkers at admission for PPROM could predict adverse
perinatal outcomes.
Keywords
pregnancy - prematurity - preterm premature rupture of membranes - chorioamnionitis
- amniotic fluid - biomarkers
