The purpose of this study was to determine if an elevated concentration of soluble fms-like tyrosine kinase- 1(sFlt- 1) in maternal plasma and amniotic fluid is a risk factor for the subsequent development of preeclam...The purpose of this study was to determine if an elevated concentration of soluble fms-like tyrosine kinase- 1(sFlt- 1) in maternal plasma and amniotic fluid is a risk factor for the subsequent development of preeclampsia. Study design: A case-control study was conducted to compare mid-trimester concentrations of maternal plasma and amniotic fluid sFlt- 1 in patients who developed preeclampsia with those who did not. The study included 32 cases with preeclampsia (18 cases: severe preeclampsia) and 128 matched controls with normal outcomes. Patients with an abnormal fetal karyotype or major anomaly, multiple pregnancies, chronic hypertension, diabetes, and renal disease were excluded. Soluble Flt- 1 concentration was measured by specific immunoassay. Nonparametric techniques were used for statistical analysis. Results: 1)The median maternal plasma, but not amniotic fluid, sFlt- 1 concentration in patients who developed preeclampsia was significantly higher than in the control cases (maternal plasma: median 730 pg/mL, range 60- 3375 pg/mL vs median 441 pg/mL, range 58- 1959 pg/mL, P < .05; amniotic fluid: median 10,504 pg/mL, range 5253- 38,023 pg/mL vs median 10,236 pg/mL, range 4326- 87,684 pg/mL, P = .65). 2) The median plasma concentration of sFlt- 1 was higher in cases of severe preeclampsia than in those with mild preeclampsia without reaching statistical significance (median 762 pg/mL, range 261- 3309 pg/mL vs median 334 pg/mL, range 60- 3375 pg/mL; P = .07). However, there was no significant difference in the median amniotic fluid sFlt- 1 concentrations between patients with severe preeclampsia and those with mild preeclampsia (P = .45). 3) An elevated maternal plasma sFlt- 1 concentration (higher than 700 pg/mL) is a risk factor for the development of preeclampsia (OR 3.9, 95% CI 1.7- 8.6) and severe preeclampsia (OR 7.4, 95% CI 2.5- 22.1) after genetic amniocentesis. 4) The median interval from amniocentesis to the diagnosis of preeclampsia in patients with maternal plasma sFlt- 1 concentrations higher than 700 pg/mL was 117 days (range 19- 154 days). Conclusion: An elevated concentration of sFlt- 1 in maternal plasma at the time of mid-trimester amniocentesis is a risk factor for the subsequent development of preeclampsia.展开更多
This study was conducted to determine the frequency and clinical significance of intra amniotic inflammation in patients with preterm premature rupture of the membranes. Amniotic fluid was retrieved from 219 patients ...This study was conducted to determine the frequency and clinical significance of intra amniotic inflammation in patients with preterm premature rupture of the membranes. Amniotic fluid was retrieved from 219 patients with preterm premature rupture of the membranes; the fluid was cultured for aerobic and anaerobic bacteria and mycoplasmas and assayed for neutrophil collagenase, which is also known as matrix metalloprotein ase- 8. Matrix metalloproteinase- 8 was used because previous studies indicated that this was a sensitive and specific index of inflammation and that is correlated with the amniotic fluid white blood cell count. Intra amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase- 8 concentration (>23 ng/mL). Nonparametric and survival techniques were used for statistical analysis. The overall rate of intra amniotic inflammation was 42% (93/219 samples); proven intra amniotic infection was detected only in 23% (50/219 samples). Intraamniotic inflammation with a negative amniotic fluid culture for micro organisms was found in 23% (51/219 samples) and was as common as proven intra amniotic infection. Pregnancy outcome was worse in patients with intra amniotic inflammation and a negative culture than in those patients with a negative culture and without inflammation. There were no differences in the interval to delivery or rate of complications between patients with intra amniotic inflammation and a negative culture and patients with proven amniotic fluid infection. We conclude that intra amniotic inflammation, regardless of culture result, is present in 42% of patients with preterm premature rupture of the membranes and that it is a risk factor for impending preterm delivery and adverse outcome. We propose that intra amniotic inflammation, rather than infection, be used to classify and treat patients with preterm premature rupture of the membranes.展开更多
文摘The purpose of this study was to determine if an elevated concentration of soluble fms-like tyrosine kinase- 1(sFlt- 1) in maternal plasma and amniotic fluid is a risk factor for the subsequent development of preeclampsia. Study design: A case-control study was conducted to compare mid-trimester concentrations of maternal plasma and amniotic fluid sFlt- 1 in patients who developed preeclampsia with those who did not. The study included 32 cases with preeclampsia (18 cases: severe preeclampsia) and 128 matched controls with normal outcomes. Patients with an abnormal fetal karyotype or major anomaly, multiple pregnancies, chronic hypertension, diabetes, and renal disease were excluded. Soluble Flt- 1 concentration was measured by specific immunoassay. Nonparametric techniques were used for statistical analysis. Results: 1)The median maternal plasma, but not amniotic fluid, sFlt- 1 concentration in patients who developed preeclampsia was significantly higher than in the control cases (maternal plasma: median 730 pg/mL, range 60- 3375 pg/mL vs median 441 pg/mL, range 58- 1959 pg/mL, P < .05; amniotic fluid: median 10,504 pg/mL, range 5253- 38,023 pg/mL vs median 10,236 pg/mL, range 4326- 87,684 pg/mL, P = .65). 2) The median plasma concentration of sFlt- 1 was higher in cases of severe preeclampsia than in those with mild preeclampsia without reaching statistical significance (median 762 pg/mL, range 261- 3309 pg/mL vs median 334 pg/mL, range 60- 3375 pg/mL; P = .07). However, there was no significant difference in the median amniotic fluid sFlt- 1 concentrations between patients with severe preeclampsia and those with mild preeclampsia (P = .45). 3) An elevated maternal plasma sFlt- 1 concentration (higher than 700 pg/mL) is a risk factor for the development of preeclampsia (OR 3.9, 95% CI 1.7- 8.6) and severe preeclampsia (OR 7.4, 95% CI 2.5- 22.1) after genetic amniocentesis. 4) The median interval from amniocentesis to the diagnosis of preeclampsia in patients with maternal plasma sFlt- 1 concentrations higher than 700 pg/mL was 117 days (range 19- 154 days). Conclusion: An elevated concentration of sFlt- 1 in maternal plasma at the time of mid-trimester amniocentesis is a risk factor for the subsequent development of preeclampsia.
文摘This study was conducted to determine the frequency and clinical significance of intra amniotic inflammation in patients with preterm premature rupture of the membranes. Amniotic fluid was retrieved from 219 patients with preterm premature rupture of the membranes; the fluid was cultured for aerobic and anaerobic bacteria and mycoplasmas and assayed for neutrophil collagenase, which is also known as matrix metalloprotein ase- 8. Matrix metalloproteinase- 8 was used because previous studies indicated that this was a sensitive and specific index of inflammation and that is correlated with the amniotic fluid white blood cell count. Intra amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase- 8 concentration (>23 ng/mL). Nonparametric and survival techniques were used for statistical analysis. The overall rate of intra amniotic inflammation was 42% (93/219 samples); proven intra amniotic infection was detected only in 23% (50/219 samples). Intraamniotic inflammation with a negative amniotic fluid culture for micro organisms was found in 23% (51/219 samples) and was as common as proven intra amniotic infection. Pregnancy outcome was worse in patients with intra amniotic inflammation and a negative culture than in those patients with a negative culture and without inflammation. There were no differences in the interval to delivery or rate of complications between patients with intra amniotic inflammation and a negative culture and patients with proven amniotic fluid infection. We conclude that intra amniotic inflammation, regardless of culture result, is present in 42% of patients with preterm premature rupture of the membranes and that it is a risk factor for impending preterm delivery and adverse outcome. We propose that intra amniotic inflammation, rather than infection, be used to classify and treat patients with preterm premature rupture of the membranes.
