MARKERS OF INFECTION AND THEIR RELATIONSHIP TO PRETERM DELIVERY

In this study we evaluated different markers of infection and their re lationship to preterm delivery. Forty-four consecutive women with sing leton pregnancies in uncomplicated preterm labor were investigated. C- reactive protein (CRP) in peripheral maternal blood, amniotic fluid cy tokines, amniotic fluid leukocyte count, and amniotic fluid culture we re performed in all patients. Thirty-six patients responded to standar d tocolytic therapy and delivered after 34 weeks' gestation. In eight patients treatment failed and they delivered before 34 weeks' gestatio n. Two of these eight patients had a positive amniotic fluid culture f or Ureaplasma urealyticum. The positive culture was accompanied by an elevated neutrophil count in the amniotic fluid. Elevated amniotic flu id levels of tumor necrosis factor (TNF) (more than 23 pg/mL), interle ukin-6 (IL-6) (more than 2292 pg/mL) and interleukin-8 (more than 164 pg/mL) correlated with early preterm delivery. CRP levels in serum had a low sensitivity (38%) but a high specificity (94%) in predicting pr eterm delivery. This study indicates that preterm labor can be initiat ed by infection. Markers of infection obtained by amniocentesis have a better sensitivity and positive predictive value than noninvasive mar kers. Elevated IL-6 (more than 2292 pg/mL) seems to be the best predic tor for preterm delivery, with a sensitivity of 75% and a specificity of 97%.