DETECTION OF TUMOR-NECROSIS-FACTOR-ALPHA, INTERLEUKIN-6, AND FETAL FIBRONECTIN IN THE LOWER GENITAL-TRACT DURING PREGNANCY - RELATION TO OUTCOME

OBJECTIVE: Our purpose was to determine whether tumor necrosis factor- alpha, interleukin-6, and fetal fibronectin could be identified in the lower genital tract during pregnancy and whether their occurrence was associated with preterm delivery. STUDY DESIGN: A prospective cohort study was undertaken of 111 pregnant women in which cervicovaginal swa bs were obtained at < 37 weeks' gestation. Seventy-three specimens wer e obtained from women during routine prenatal examination, whereas 38 specimens were obtained from women undergoing evaluation of preterm la bor. Interleukin-6 and fetal fibronectin levels were determined by enz yme-linked immunosorbent assays, whereas tumor necrosis factor-alpha d eterminations were by bioassay. Urinary tract and lower genital tract samples were cultured for evidence of infection. The rates of maternal and neonatal complications were assessed. RESULTS: In patients underg oing evaluation for preterm labor the presence of tumor necrosis facto r-cc or fetal fibronectin was associated with an increased prevalence of preterm delivery. Women with tumor necrosis factor-alpha had a 6.19 greater risk (p < 0.005), whereas the presence of fetal fibronectin w as associated with a 4.81 greater risk (p < 0.05), of preterm birth. T his association was not evident in women who were sampled during routi ne prenatal examinations. In all women the presence of cytokines in th e lower genital tract correlated with detection of fetal fibronectin. CONCLUSION: Localized inflammatory responses may lead to microscopic d isruption in the amniotic membranes, leading to leakage of fibronectin . In patients being evaluated for preterm labor, the presence of tumor necrosis factor-alpha or fetal fibronectin in the lower genital tract is predictive of subsequent preterm delivery.