THE RELATIONSHIP BETWEEN AMNIOTIC FLUID WHITE BLOOD CELL COUNT AND INFLAMMATORY LESIONS OF THE PLACENTA IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

Eun Ha Jeong; Kyo Hoon Park; Kyung Joon Oh; Sung Youn Lee; Shi Nae Kim; Hee Jung Jung; Jeong Yeun Lee

doi:10.5468/KJOG.2011.54.2.79

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Jeong, Park, Oh, Lee, Kim, Jung, and Lee: THE RELATIONSHIP BETWEEN AMNIOTIC FLUID WHITE BLOOD CELL COUNT AND INFLAMMATORY LESIONS OF THE PLACENTA IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

Original Article

Korean J Obstet Gynecol 2011;54(2):79-85.

Published online: 21 January 2011

DOI: https://doi.org/10.5468/KJOG.2011.54.2.79

THE RELATIONSHIP BETWEEN AMNIOTIC FLUID WHITE BLOOD CELL COUNT AND INFLAMMATORY LESIONS OF THE PLACENTA IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

Eun Ha Jeong, MD, Kyo Hoon Park, MD, PhD, Kyung Joon Oh, MD, Sung Youn Lee, MD, Shi Nae Kim, MD, Hee Jung Jung, MD, Jeong Yeun Lee, RN

Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Corresponding author: Kyo Hoon Park, MD, PhD Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea Tel: +82-31-787-7252 Fax:+82-31-787-4054 E-mail: pkh0419@snubh.org

^∗ This study was supported by a grant from Seoul National University Bundang Hospital (02-2009-019).

Received 30 November 2010 Revised 18 January 2011 Accepted 20 January 2011

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 examine the relationship between amniotic fluid (AF) white blood cell (WBC) count and the presence and severity of inflammatory lesions of the placenta in women with preterm premature rupture of membranes (PPROM).

Methods

This retrospective cohort study included 90 consecutive women with PPROM (24.0-35.6 weeks) who met the following criteria: singleton gestation; transabdominal amniocentesis performed to obtain AF for culture and WBC count; delivery within 72 hours of amniocentesis; placental histologic examination after preterm delivery.

Results

The prevalence of histologic chorioamnionitis was 32% (29/90) and that of positive amniotic fluid culture was 21% (19/90). Patients with histologic chorioamnionitis had a significantly higher AF WBC count than those without this lesion. Logistic regression analysis demonstrated that AF WBC count had a significant relationship with histologic chorioamnionitis after controlling for gestational age and AF culture. The median AF WBC count increased significantly according to the higher severity of inflammation in each type of placental histologic section. According to receiver operating characteristic curve analysis, the best cutoff value of AF WBC count for predicting histological chorioamnionitis was 25 cells/mm³, with a sensitivity of 62% and a specificity of 77%.

Conclusion

Both the presence and greater severity of inflammatory lesions of the placenta are associated with an elevated AF WBC count. AF WBC count is an important and independent predictor for inflammatory lesions of the placenta in women with PPROM.

Keywords: Amniotic fluid, White blood cell, Placenta, Inflammatory lesions, Preterm premature rupture of membranes

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Fig. 1.

Receiver operating characteristic curve for amniotic fluid white blood cell in predicting the occurrence of histologic chorioamnionitis. Number next to solid dots represents cutoff value of white blood cell (area under the curve 0.716; standard errors 0.065; P=0.001).

Table 1.

Histological grade for acute intrauterine inflammation

Amnion

Grade 1: at least one focus of >5 neutrophils

Grade 2: diffuse neutrophilic infiltration

Chorion-decidua

Grade 1: at least one focus of >5 neutrophils

Grade 2: diffuse neutrophilic infiltration

Umbilical cord

Grade 1: neutrophilic infiltration confined to umbilical vessel wall

Grade 2: extension of neutrophilic infiltration into Wharton's jelly

Chorionic plate

Grade 1: >1 focus of at least 10 neutrophilic collections or diffuse infiltration in subchorionic plate

Grade 2: diffuse and dense inflammation, neutrophilic infiltration into connective tissue of placental plate, or placental vasculitis

Table 2.

Demographic and clinical characteristics of the study population according to the histologic chorioamnionitis

Characteristics	Histologic chorioamnionitis		P‐value
Characteristics	Absent (n=61)	Present (n=29)	P‐value
Maternal age (yr)	30.8±4.0	30.6±3.1	0.538
Nulliparity	49% (30/61)	52% (15/29)	1.0
Gestational age at amniocentesis (wk)	34.0±1.4	31.0±3.3	<0.001
Amniotic fluid WBC count (cells/mm³)	103±345	2,047±3,558	0.001
Positive amniotic fluid culture	8% (5/61)	48% (14/29)	<0.001

Values are given as mean±standard deviation or % (n).

Table 3.

Risk factors associated with histologic chorioamnionitis after adjustment of confounding variables by logistic regression

	Odds ratio	95% CI	P-value
Gestational age at amniocentesis (wk)	0.632	0.487-0.820	0.001
Amniotic fluid WBC count (cells/mm³)	1.001	1.000-1.002	0.038
Positive amniotic fluid culture	4.295	1.058-17.435	0.041

CI, confidence interval; WBC, white blood cell.

Table 4.

Amniotic fluid culture and white blood cell count according to the presence and severity of inflammation in each type of placental histologic section

Tissue	n	Positive amniotic fluid culture	P‐value^∗	Amniotic fluid WBC	P‐value^†
Amnion
Grade 0	82	14 (17)	0.006	6.5 (0‐10880)	0.067
Grade 1	6	3 (50)		910 (0‐8160)
Grade 2	1	1 (100)		12100
Chorion‐decidua
Grade 0	62	5 (8)	<0.001	5 (0‐2020)	0.001
Grade 1	18	9 (50)		55 (0‐8160)
Grade 2	10	5 (50)		2120 (0‐12100)
Umbilical cord
Grade 0	77	11 (14)	<0.001	5 (0‐12100)	<0.001
Grade 1	6	3 (50)		975 (5‐5440)
Grade 2	7	5 (71)		1600 (80‐10880)
Chorionic plate
Grade 0	78	14 (18)	0.021	6 (0‐9760)	0.001
Grade 1	6	2 (33)		17.5 (0‐1680)
Grade 2	5	3 (60)		8160 (1001‐12100)

Values are given as n (%) or median (range).

WBC, white blood cell.

^∗ Chi‐square test for trend

^† Kruskal‐wallis test.

Table 5.

Amniotic fluid white blood cell count according to the total grade of histologic chorioamnionitis

Total grade of histologic chorioamnionitis	n	Amniotic fluid white blood cell	P‐value^∗
Grade 0	61	5 (0‐2020)	<0.001
Grade 1 or 2	14	5 (0‐1880)
Grade 3 or 4	9	680 (0‐9760)
Grade 5 or 6	6	4920 (1001‐12100)
Grade 7 or 8	0

Values are given as median (range).

^∗ Kruskal‐wallis test.

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