Dh. Watts et al., CHARACTERISTICS OF WOMEN IN PRETERM LABOR ASSOCIATED WITH ELEVATED C-REACTIVE PROTEIN-LEVELS, Obstetrics and gynecology, 82(4), 1993, pp. 509-514
Objective: To evaluate clinical, microbiologic, and histologic finding
s associated with elevated C-reactive protein levels among women in pr
eterm labor or with preterm premature rupture of the membranes (PROM).
Methods: Obstetric data, serum C-reactive protein levels, and amnioti
c fluid (AF) and chorioamniotic membrane cultures and histology were o
btained on 203 women presenting between 22-34 weeks' gestation in pret
erm labor or with PROM. Results: Women with C-reactive protein greater
than 1.5 mg/dL were more likely to deliver within 7 days of enrollmen
t (54 of 68, 79%) than were women with normal C-reactive protein level
s (45 of 135, 33%) (P < .001). The median C-reactive protein levels an
d association with rapid delivery did not differ between women with in
tact versus ruptured membranes. Elevated C-reactive protein levels wer
e associated with a positive AF culture among women in preterm labor w
ith intact membranes. To control for confounding by a long interval to
delivery, only the group delivering within 7 days was considered for
evaluation of C-reactive protein levels and placental and infant outco
me. Among women delivering within 7 days, elevated C-reactive protein
was associated with the development of clinical chorioamnionitis and w
ith infant death before hospital discharge, but not with a positive me
mbrane culture or histologic chorioamnionitis. Conclusions: Elevated C
-reactive protein appears to be associated with AF infection, delivery
within 7 days of admission, and infant death among women delivering p
reterm, but not with membrane infection or inflammation. Elevated C-re
active protein may be helpful in determining the need for AF culture a
nd in targeting studies of antibiotic therapy among women in preterm l
abor or with preterm PROM.