CHANGES IN PLASMA ELASTASE DURING PREGNANCY AND SUB PARTU

Elastase is produced and released by polymorphonuclear leukocytes (PNM s) during inflammatory processes. Thus, elastase is assumed to be a se nsitive marker of infections similar to the well-established C-reactiv e protein (CRP). It is deactivated predominantly in tissues by al-prot einase inhibitor which forms stable complexes with the elastase molecu le (EAPI) that can be detected for several hours. Premature rupture of membranes is often correlated with an early increase in elastase, occ urring earlier than the increase in leukocyte count or CRP. Elastase m ight be a sensitive marker of beginning amnion infection syndrome afte r premature rupture of membranes. For the present study, plasma EAPI l evels of 335 healthy pregnant women as well as 47 healthy nonpregnant pre-and postmenopausal women were analyzed. No significant differences were found in the latter group or in pregnant women until the beginni ng of labor. Women at the beginning of labor but without rupture of me mbranes showed a significant increase in plasma EAPI from 97.7 to 338. 3 ng/ml (p < 0.001). With opening of the os uteri to more than 2 cm, e lastase concentrations decreased to values comparable to those before the beginning of labor (p < 0.001). The use of elastase as a marker fo r a rupture of membranes or beginning amnion infection syndrome as sug gested by a number of studies might need some restriction. As a conseq uence, serial monitoring of plasma elastase to detect a persisting inc rease might give more reliable results. The increase in plasma elastas e during beginning of labor may be explained by the role of PMNs in th e physiology of delivery. However, serial monitoring to detect a persi sting increase in plasma EAPI may be more helpful.