Objective-Discolored amniotic fluid (AF) has been associated with intra-amniotic infection/ inflammation (IAI) in patients with preterm labor (PTL). The presence of hemoglobin and its catabolic products have been implicated as a cause for AF discoloration. The aim of this study was to determine whether there is an association between total hemoglobin concentration in AF and gestational age, spontaneous labor (term and preterm) and the presence or absence of IAI.Study design-This cross-sectional study included patients in the following groups: 1) midtrimester (n=65); 2) term not in labor (n=22); 3) term in labor (n=47); 4) spontaneous PTL who delivered at term (n=92); 5) PTL without IAI who delivered preterm (n=76); 6) PTL with IAI (n=81); 7) preterm prelabor rupture of the membranes (PPROM) with IAI (n=48); and 8) PPROM without IAI (n=49). Total hemoglobin concentrations in amniotic fluid were determined by an enzyme-linked immunoassay. Non-parametric statistics were used for analysis.
Results-1)Hemoglobin was detected in all AF samples (n=480); 2) The median AF total hemoglobin concentration at term was significantly higher than in mid-trimester [520.6 ng/mL, interquartile range (IQR) 271.2-1549.2 vs. 58.5 ng/mL, IQR 26. 1-200.8; p<0.001]; 3) Among patients with PTL, the median AF total hemoglobin concentration was significantly higher in patients with IAI than in those without IAI (4671.8 ng/mL, IQR 1294.2-8620.7 vs. 2013.6 ng/mL, IQR 629.2-5420.4; p=0.01) or women who delivered at term (1143.4 ng/mL, IQR 451.8-4037.9; p=0.001); 4) Similarly, among patients with PPROM, the median AF total hemoglobin concentration was significantly higher in patients with IAI than in those without IAI (10753.7 ng/mL, IQR 2053.9-56026.6 vs. 2281 ng/mL, IQR 938.2-9191.7; p=0.02); 5) Women at term in labor had a higher median hemoglobin concentration than those not in labor (1952.6 ng/mL, IQR 709.6-6289.2 vs. 520.6 ng/ mL, IQR 271.1-1549.2; p=0.003).