Use of C‐reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of membranes: a systematic review

Trochez-Martinez, R.D.; Smith, Philip G.; Lamont, Ronnie

doi:10.1111/j.1471-0528.2007.01385.x

Cited by 118 publications

(108 citation statements)

References 25 publications

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“…Meanwhile, another systematic review of scientific work including 8 studies and 610 patients claims that there is no clear correlation between increased CRP levels and early diagnosis of chorioamnionitis. It is due to the fact that critical CRP values vary greatly from 5 to 40 mg/l (35). A study by Perrone et al did not prove any significant prognostic value of the WBC count, the same as our study (30).…”

Section: Discussionsupporting

confidence: 74%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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Background. The study investigates the influence of the length of membrane rupture period among pregnant women with preterm premature rupture of membranes (PPROM) between the 32nd and 34th weeks of gestation on the development of chorioamnionitis and the congenital infection of a newborn. It seeks to ascertain the values of indicators in mother's blood that enable to predict chorioamnionitis and funisitis for mothers, and congenital infection for newborns.Materials and methods. A retrospective study of case records of women with PPROM at 32 (32 w. + 0 d)-34 (33 w. + 6 d) weeks of gestation and their newborns was performed. Two comparative groups were made: 1) of women who had funisitis and / or chorioamnionitis with or without deciduitis and 2) of women having no proved inflammation (according to the results of histological examination of placentae). Analogically, comparative groups were made of their newborns: those who had diagnosis of congenital infection and those who had no infection. The duration of membrane rupture period and the blood markers were investigated in all the groups.Results. The study included 135 women. Duration of the membrane rupture period lasted 85.17 ± 84.72 hrs in the group of women who had histological inflammation, and 40.06 ± 56.57 hrs in the group with no inflammation, P = 0.01, AUC = 0.735; the critical membrane rupture period value for developing intrauterine infection by the Youden index was 43.7 hrs. The corresponding maternal CRP values (mg/l) were 25.85 ± 40.27 vs. 5.23 ± 7.88 (P = 0.01, AUC = 0.6), the Youden index 4.6 mg/l. For the mothers of the newborns diagnosed with infection, the duration of the membrane rupture period was 55.95 ± 65.04 hrs, for the mothers of the newborns without congenital infection it was 40.25 ± 73.71 hours. Respectively, CRP values for the mothers of newborns averaged 12.25 ± 22.14 mg/l vs. 4.8 ± 4.82 mg/l (P = 0.005).Conclusions. Longer membrane rupture period and higher maternal CRP are correlated with inflammatory changes in the placenta and umbilical cord, thus they can be used as the prognostic indicators of intrauterine infection. When the duration of the membrane rupture period lasts ≥44 hrs, the risk of chorioamnionitis and funisitis increases five times; when the maternal serum CRP is higher than 5 mg/l, funisitis / chorioamnionitis is twice more frequent than at lower than 5 mg/l CRP values.

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Section: Discussionsupporting

confidence: 74%

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Daunoravičienė¹,

Musteikytė²,

Ramašauskaitė³

2015

AML

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“…This finding is in accord with some recently published data showing that measurement of PCT in maternal blood is unreliable in the clinical diagnosis of chorioamnionitis 2 . Despite conflicting evidence, our study showed significant elevation in maternal WBC and CRP in the chorioamnionitis positive group 12,13 . In our study, PCT was elevated in umbilical cord Table 2.…”

Section: Discussioncontrasting

confidence: 61%

Procalcitonin is more likely to be released by the fetus rather than placental tissue during chorioamnionitis

Straňák¹,

Feyereisl²,

Korček³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. To analyze the relationship between maternal, cord blood and neonatal procalcitonin (PCT) levels in preterm deliveries with and without histologically proven chorioamnionitis (HCA). Methods. 91 mother-infant pairs from 24+0 to 33+0 gestational weeks were analyzed. Procalcitonin was measured in all mothers within 24 hours before and subsequently in cord blood and in neonates within the first two hours after delivery. PCT levels were analysed in relationship to HCA and clinical outcome. Results. HCA was confirmed in 28 cases (31%). We found no differences in PCT values between HCA positive and negative groups in maternal blood (0.1±0.1 vs 0.09±0.09 ng/L, P = 0.76). PCT values in cord blood and neonates were significantly higher in the HCA positive compared to HCA negative group (0.23±0.1 vs 1.2±2.7 ng/L, P < 0.001 and 0.89±3.4 vs 4.2±9.3 ng/L, P < 0.0001 respectively). PCT values in neonates were significantly higher than those of cord blood. Levels were not influenced by the mode of delivery, gestational age or premature rupture of membranes. Chorioamnionitis was more frequently associated with early onset neonatal sepsis (36% in HCA group vs 5% in non HCA group, P < 0.0001). Comparison of other clinical data revealed no differences between HCA positive and negative groups. Conclusion. This study showed higher PCT in cord and neonatal blood in the presence of proven histological chorioamnionitis. The measurement of PCT in mothers' blood is not helpful for diagnosis of HCA. The changes in PCT values shown suggest its production and release by fetal tissue.

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“…12 Although maternal serum level of CRP slightly increases within gestational age, still this marker is used as an indicator of intrauterine infection, especially in pPROM cases [13][14][15][16][17][18] nevertheless reports that its benefits are conflicting. 19,20 On the contrary, there are only a few published data on CRP in vaginal fluid during pregnancy or its complications.…”

Section: Introductionmentioning

confidence: 99%

Maternal serum and vaginal fluid C-reactive protein levels do not predict early-onset neonatal infection in preterm premature rupture of membranes

Torbé

Kowalski

2010

J Perinatol

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Objective: The aim of this study was to evaluate the usefulness of maternal serum and vaginal fluid C-reactive protein (CRP) determinations in the prediction of neonatal congenital infection.Study Design: Fifty women between 24 and 36 weeks gestation, complicated by preterm premature rupture of membranes (pPROM), were divided into two groups according to the presence (n ¼ 14) or absence (n ¼ 36) of early-onset newborns' infection.Result: Maternal serum and vaginal fluid CRP concentrations were comparable between both groups. Serum CRP levels X10 and X15 mg l -1 predicted neonatal infection with a sensitivity of 47 and 47%, specificity of 63 and 76%, positive predictive value (PPV) of 38 and 47%, and negative predictive value (NPV) of 72 and 76%, respectively. The cutoff value of vaginal CRP X2.4 mg l -1 predicted infection with a sensitivity of 71%, specificity of 47%, PPV of 34%, and NPV of 81%. Receiver-operating characteristic curve analysis revealed that the predictive performance of CRP was poor.Conclusion: Maternal serum and vaginal fluid CRP determinations after pPROM are of poor predictive value in neonatal early-onset infection prediction.

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Use of C‐reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of membranes: a systematic review

Cited by 118 publications

References 25 publications

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Preterm premature rupture of membranes at 32–34 weeks of gestation: duration of membrane rupture period and maternal blood indicators relation with congenital infection

Procalcitonin is more likely to be released by the fetus rather than placental tissue during chorioamnionitis

Maternal serum and vaginal fluid C-reactive protein levels do not predict early-onset neonatal infection in preterm premature rupture of membranes

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