Intrauterine Infection Predictors among Preterm Premature Rupture of Membrane Patients
Author(s): Ali Sungkar, Raymond Surya*, Rima Irwinda, Budi Iman Santoso
Introduction: The preterm premature rupture of membrane (PPROM) complicates pregnancy for 1% to 2% of all women and it is associated with 30% to 40% of preterm birth. It is difficult to determine whether infection as the cause or consequence of preterm delivery. Therefore, this study aimed to review several markers to predict intrauterine infection for good management among PPROM patients.
Methods: The author searched in PubMed, Cochrane, and Ovid using searching strategy “MeSH”. There were 25, 20, and 2 articles found in PubMed, Cochrane, and Ovid; respectively which finally ended to 8 cohort or case control studies and 2 systematic reviews. Critical appraisal was based on validity, importance, and applicability (VIA).
Results: In maternal parameters, sensitivity of temperature, heart rate, leucocyte count, and CRP were low without regarding the infection. Besides, biophysical profile score and fetal heart activity were insensitive to predict intrauterine infection. Fetal marker such as leucocyte and neutrophil count was increased in intrauterine infection; however, it was not specific. Positive amniotic fluid Gram stain revealed a high sensitivity (80%) in prediction of intrauterine infection with aerobic or anaerobic organism. Procalcitonin should be considered as weak predictor for intrauterine infection (low sensitivity). Essential markers for predicting intrauterine infection non-invasively were IL-6 and TNF-α.
Conclusion: Amniotic fluid IL-6 and TNF-α are strong predictors for fetal inflammatory response syndrome (FIRS) and/or histological funisitis.