Journal
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Volume 185, Issue 5, Pages 1149-1155Publisher
MOSBY, INC
DOI: 10.1067/mob.2001.118165
Keywords
matrix metalloproteinase; intra-amniotic infection; preterm labor; neonatal death; neonatal morbidity; MMP-8
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OBJECTIVE: Intra-amniotic inflammation Is a major determinant of maternal and neonatal outcome in patients with preterm labor. Matrix metalloproteinase-8 is a sensitive marker of inflammation in body fluids. This study was conducted to examine the value of amniotic fluid matrix metalloproteinase-8 determinations In patients with preterm, labor and Intact membranes, STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis from 371 patients with preterm labor. Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Amniotic fluid analysis included Gram stain examination, white blood cell count, and matrix metalloproteinase-8 (enzyme-linked immunosorbent assay) determination. Nonparametric statistics were used for analysis. RESULTS: The rate of preterm delivery was 54% (200/371) and that of intra-amniotic infection was 9.2% (34/371). The median amniotic fluid matrix metalloproteinase-8 concentration was more than 50-fold higher In patients with Intra-amniotic infection than in patients with no intra-amniotic Infection (median, 605.6 ng/mL; range, 0.65-15,000 ng/mL vs median, 10.6 ng/mL; range, <0.06-16,600 ng/mL, respectively P < .0001). The matrix metalloproteinase-8 amniotic fluid concentrations were significantly higher in patients who delivered preterm than in patients who delivered at term (median, 19.5 ng/mL; range, <0.06-16,600 ng/mL vs median, 2.1 ng/mL; range, <0.06-500 ng/mL, respectively; P < .001). After exclusion of patients with intra-amniotic Infection, patients who delivered preterm had a significantly higher median amniotic fluid matrix metalloproteinase-8 than patients who delivered at term (P < .05). An amniotic fluid matrix metalloproteinase-8 level of > 30 ng/mL was an independent predictor for the occurrence of neonatal morbidity (odds ratio, 3.4; 95% Cl, 1.9-5.8; P < .01). CONCLUSION: Increased amniotic fluid matrix metalloproteinase-8 concentrations identify patients at risk for intra-amniotic infection, Impending preterm delivery, and adverse neonatal outcome.
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