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Yoon, Kim, Kim, Cho, Kim, Cho, Kim, Kang, Lee, and Song: Maternal serum levels of C-reactive protein and placental levels of IL-6, lipid peroxide, and protein carbonyl in preterm birth according to histologic chorioamnionitis
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2011; 54(1): 26-36.

Published online: 31 January 2011

DOI: https://doi.org/10.5468/KJOG.2011.54.1.26

Maternal serum levels of C-reactive protein and placental levels of IL-6, lipid peroxide, and protein carbonyl in preterm birth according to histologic chorioamnionitis

Dae-Seok Yoon, MD1, Yoon Ha Kim, MD1, Chul Hong Kim, MD1, Moon Kyoung Cho, MD1, Jong Woon Kim, MD1, Hye Yon Cho, MD1, Seok Mo Kim, MD1, Woo Dae Kang, MD1, Ki Ho Lee, MD2, Tae-Bok Song, MD1

1Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.

2Department of Obstetrics and Gynecology, Seonam University College of Medicine, Namwon, Korea.

Corresponding author: Yoon Ha Kim, MD, PhD. Department of Obstetrics and Gynecology, Chonnam National University Medical School, 8 Hag-dong, Dong-gu, Gwangju 501-190, Korea. Tel: +82-62-220-6375, Fax: +82-62-227-1637, kimyh@chonnam.ac.kr

Received 5 November 2010       Accepted 14 December 2010

Copyright © 2011. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate predictive value of maternal serum white blood cells (WBCs), C-reactive protein (CRP) levels, placental interleukin-6 (IL-6), lipid peroxide, and protein carbonyl levels in preterm birth according to histologic chorioamnionitis (HCA).

Methods

This cohort study included 45 cases of preterm delivery with preterm labor and intact membranes (preterm labor [PTL] group; n=16) and preterm premature rupture of membranes (preterm premature rupture of membranes [PPROM] group; n=29). Blood samples at admission and placental sample at postpartum were collected. HCA was diagnosed in the presence of neutrophils infiltration into the subamnionic space.

Results

The incidence of HCA was significantly higher in PPROM group than PTL group. Maternal serum WBC and CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels in HCA group were significantly higher than group without HCA. Maternal serum CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels of PPROM group with HCA were significantly higher than PPROM group without HCA. Maternal serum CRP levels at admission of 7 days and more latency period (n=14) were significantly lowered than those of less than 7 days latency period (n=15). The cut-off points of CRP determined with the receiver operating characteristic curves was 0.875 mg/dL. Perinatal morbidity such as respiratory distress syndrome, intraventricular hemorrhage, pneumonia in HCA group was significantly higher than group without HCA.

Conclusion

Maternal serum CRP on admission may be possible a predictor for duration of the latency period in PPROM.

Keywords: Preterm birth, Histologic chorioamnionitis, C-reactive protein, Lipid peroxides, Protein carbonyls

Figures and Tables

Fig. 1
Flowsheet of patient enrollment. PTL, preterm labor with intact membranes; PPROM, preterm premature rupture of membranes; HCA, histologic chorioamnionitis.
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Fig. 2
Histologic findings of normal chorioamnion, acute chorioamnionitis, normal umbilical cord and acute funisitis. (A) Normal amnion; single layer of epithelial cells and underlying connective tissue. (B) Acute chorioamnionitis; neutrophils accumulation in the subamnionic space (arrow). (C) Normal venous wall of the umbilical cord. (D) Acute funisitis; neutrophils exudation into the venous wall (arrow). (H&E, ×200).
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Fig. 3
PTL with and without histologic chorioamnionitis. (A) white blood cell (WBC), (B) C-reactive protein (CRP), (C) interleukin-6 (IL-6), (D) lipid peroxides level, (E) protein carbonyls level. PTL, preterm labor with intact membranes; MDA, malondialdehyde.
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Fig. 4
PPROM with and without histologic chorioamnionitis. (A) white blood cell (WBC), (B) C-reactive protein (CRP), (C) interleukin-6 (IL-6), (D) lipid peroxides level, (E) protein carbonyls level. PPROM, preterm premature rupture of membranes; MDA, malondialdehyde.
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Fig. 5
Duration of the latency period (admission to delivery interval) in PPROM group. (A) white blood cell (WBC), (B) C-reactive protein (CRP), (C) interleukin-6 (IL-6), (D) Lipid peroxides level, (E) Protein carbonyls level. PPROM, preterm premature rupture of membranes; MDA, malondialdehyde.
kjog-54-26-g005
Fig. 6
Receiver operating characteristic curve for C-reactive protein in maternal serum on admission in predicting duration of the latency period in PPROM group. The cutoff levels of C-reactive protein for prediction of 7 days and more is 0.875 mg/dL (area under the curve, 0.840; standard error, 0.0742; z=4.587; P<0.01). PPROM, preterm premature rupture of membranes; ROC, receiver operating characteristic.
kjog-54-26-g006
Table 1
Characteristics and outcomes of preterm birth according to rupture of membranes
kjog-54-26-i001

Values are presented as mean±standard error or number (%).

PTL, preterm labor group; PPROM, prterm premature rupture of membranes group; NS, not significant.

Table 2
Characteristics and outcomes of preterm birth according to histologic chorioamnionitis
kjog-54-26-i002

Values are presented as mean±standard error or number (%).

NS, not significant.

Table 3
Neonatal morbidity according to histologic chorioamnionitis
kjog-54-26-i003

Values are presented as number (%).

NS, not significant.

Table 4
Estimated values in histologic chorioamnionitis patients according to funisitis
kjog-54-26-i004

Values are presented as mean±standard error.

WBC, white blood cell; CRP, C-reactive protein; IL-6, interleukin-6; MDA, malonic dialdehyde; NS, not significant.

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