Awara, A. M., Marei, S. K., Elghorab, N. M., Elnewahy, M. A., & Aboulenin, A. A. (1992). Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes. Egyptian medical journal, 9(2), 31-37.
Awara AM, Marei SK, Elghorab NM, Elnewahy MA, Aboulenin AA. Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes. Egypt Med J. 1992;9(2):31-37.
Awara, A. M., et al. "Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes." Egyptian medical journal, vol. 9, no. 2, 1992, pp. 31-37.
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Abstract
Physicians compared clinical history, examination, and laboratory data on 10 pregnant women at various gestational ages with intact membranes till labor began (controls) with data on 25 pregnant women also at various gestational ages who experienced premature rupture of membranes (PROM) (cases) to determine the value of C-reactive protein (CRP) in maternal and cord blood as a predictor of chorioamnionitis in women with PROM. 32% of cases had clinical chorioamnionitis and 44% histopathological chorioamnionitis. The maternal serum level of CRP in cases with and without chorioamnionitis at delivery was statistically higher than that of the controls (45.82 CRP mg/L and 9.71 CRP mg/L vs. 6.6 CRP mg/l; P.05). Further the CRP level in cord blood of cases with chorioamnionitis also stood much higher than that of the controls (p.001). In addition, the total leukocytic count (TLC) for cases with chorioamnionitis at delivery was much higher than it was for the control group at delivery (12,510 TLC/cubic mm vs. 18,231 TLC/cubic mm; p.05). A significant difference also existed between the temperature of the cases with chorioamnionitis and that of the controls (37.11 degrees Celsius vs. 63.97 degrees Celsius; p.05). Sensitivity and specificity tests showed that CRP 24 mg/L was the most reliable predictor of chorioamnionitis (100% and 93.3% respectively) followed by TLC (77.8% and 92.8% respectively) then temperature (55.6% and 78.6% respectively). Thus CRP can be used to predict premature delivery and simultaneously reduces unnecessary premature delivery of many PROM cases which occur due to fear of developing infections in both the mother and the fetus.
C-reactive protein (CRP) levels were evaluated during spontaneous labour, in imminent premature parturition (IPP) and after preterm rupture of oocyst membranes (PROM). Increasing CRP level during spontaneous labour was found in 16.6% parturients. Elevated CRP level in patients with IPP makes it impossible to predict premature labour. In parturients with PROM, increase in CRP level makes further infection predictable only in a few cases.
To evaluate clinical, microbiologic, and histologic findings associated with elevated C-reactive protein levels among women in preterm labor or with preterm premature rupture of the membranes (PROM). Obstetric data, serum C-reactive protein levels, and amniotic fluid (AF) and chorioamniotic membrane cultures and histology were obtained on 203 women presenting between 22-34 weeks' gestation in preterm labor or with PROM. Women with C-reactive protein greater than 1.5 mg/dL were more likely to deliver within 7 days of enrollment (54 of 68, 79%) than were women with normal C-reactive protein levels (45 of 135, 33%) (P < .001). The median C-reactive protein levels and association with rapid delivery did not differ between women with intact versus ruptured membranes. Elevated C-reactive protein levels were associated with a positive AF culture among women in preterm labor with intact membranes. To control for confounding by a long interval to delivery, only the group delivering within 7 days was considered for evaluation of C-reactive protein levels and placental and infant outcome. Among women delivering within 7 days, elevated C-reactive protein was associated with the development of clinical chorioamnionitis and with infant death before hospital discharge, but not with a positive membrane culture or histologic chorioamnionitis. Elevated C-reactive protein appears to be associated with AF infection, delivery within 7 days of admission, and infant death among women delivering preterm, but not with membrane infection or inflammation. Elevated C-reactive protein may be helpful in determining the need for AF culture and in targeting studies of antibiotic therapy among women in preterm labor or with preterm PROM.
A group of 52 patients with premature rupture of the membranes (PROM) before 34 weeks' gestation were evaluated prospectively and managed expectantly. Of 42 patients who were delivered of their infants, 26 (61.9%) had significant chorioamnionitis on histopathology, and 18 had positive microbial cultures at delivery. However, only seven patients (16.7%) developed clinical signs of chorioamnionitis. There were no maternal deaths or perinatal deaths attributable to sepsis. Only two infants (less than 5%) had positive blood cultures. All patients were assessed daily for the development of chorioamnionitis. Amniocenteses were not routinely performed. White blood cell counts, band neutrophil counts, and erythrocyte sedimentation rate determinations were found to be unreliable. C-reactive protein determinations were found most reliable with a high sensitivity and specificity. Elevated C-reactive protein levels correlated better with pathologic confirmation of chorioamnionitis than with the clinical febrile morbidity. Clinical implications for the management of PROM are discussed.
This study was designed to derive the predictive value of C-reactive protein (CRP) in peripheral venous serum of patients admitted to hospital with suspected premature rupture of the membranes (PROM). CRP was assayed by each of 4 separate methods and the results have been compared for accuracy and practical value with respect to clinical outcome and the histopathology of the placenta. Of the 4 techniques used only the latex test had characteristics suitable for a diagnostic screen. While the results were only semiquantitative, when comparisons were made to other techniques no significant change in clinical diagnosis would have been made. The results have confirmed that chorioamnionitis and preterm labour are often associated, but in some instances the extent of inflammatory infiltration was greater than might have been expected from the short time interval between documented membrane rupture and delivery. Thus it may be speculated that some cases of PROM are secondary to, rather than causative of, infection. Finally it is suggested that a controlled therapeutic trial of active intervention in those cases of PROM with elevated CRP in the absence of other clinical parameters suggestive of intrauterine infection should be undertaken.
Pregnancy › Pregnancy Complications › Premature Rupture of Membranes · General Gynecology › Infections › Vaginal and Cervical Infections
PMID 12285340 12285340 Awara et al. 1992, Awara 1992
Cite this article
Awara, A. M., Marei, S. K., Elghorab, N. M., Elnewahy, M. A., & Aboulenin, A. A. (1992). Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes. Egyptian medical journal, 9(2), 31-37.
Awara AM, Marei SK, Elghorab NM, Elnewahy MA, Aboulenin AA. Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes. Egypt Med J. 1992;9(2):31-37.
Awara, A. M., et al. "Predictive value of C-reactive protein in serum of maternal and cord blood in cases with premature rupture of membranes." Egyptian medical journal, vol. 9, no. 2, 1992, pp. 31-37.