CHARACTERISTICS OF WOMEN IN PRETERM LABOR ASSOCIATED WITH ELEVATED C-REACTIVE PROTEIN-LEVELS

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.