| BackgroundPremature rupture of membranes is defined as spontaneous membrane rupture that occurs before the onset of labor, which is a common complication of pregnancy. The fetal membranes serve as a barrier to ascending infection. Once the membranes rupture, due to ascending polymicrobial bacterial infection in the setting of membrane rupture, both the mother and fetus are at risk of infection and of other complications. Adverse maternal outcomes include postpartum infections and sepsis while adverse infant outcomes include stillbirth, premature birth, neonatal sepsis, chronic lung disease and brain injury leading to cerebral palsy and other neurodevelopmental disabilities. Although the diagnosis of premature rupture of membranes is relatively simple, but due to the onset of premature rupture of membranes for unknown reasons and no effective treatment, which makes the prevention and treatment of premature rupture of membranes is hampered by a certain, therefore caused complications after the occurrence of premature rupture of membranes become clinical research emphasis and hot.Many literature study shows that after the occurrence of premature rupture of membranes, easily complicated with chorioamnionitis, but because of the early clinical symptoms of chorioamnionitis is not obvious, it is prone to misdiagnosis, not timely control the development of the illness, resulting in serious maternal complications, Therefore, premature rupture of membranes with chorioamnionitis predictors become a research hotspot in recent years. This study focuses on the correlation of the level of pregnant women serum white blood cell count (WBC), c-reactive protein (CRP),interleukin 6 (IL-6), the amniotic fluid IL-6 and premature rupture of membranes with chorioamnionitis, and to investigate their predictive value for the PROM with chorioamnionitisObjective1. By detecting the level of maternal serum WBC, CRP, IL-6 and amniotic fluid IL-6, analysis the correlation of their levels and premature rupture of membranes with chorioamnionitis, and determine the predictive value of these tests for the PROM with chorioamnionitis.2. Through the statistical analysis to find a kind of clinical test which has high sensitivity and specificity to predict the PROM with chorioamnionitis.Methods1. This was a prospective study. From March 2013 to March 2014, the clinical information of 80 pregnant women were collected and categorized as study group with premature rupture of membranes(n=40,these patients did not use any antibiotic treatment after PROM) and control group without premature rupture of membranes and these patients choose elective cesarean(n=40). All patients were primipara and single cephalic pregnancy. Two groups of pregnant women did not have any other comorbidities and complications. no statistically significant difference in the age or week of pregnancy between PROM patients and general gestation women(P>0.05).2. The clinical examinations were as follows:routine blood test, CRP, IL-6. Patients with premature rupture of membranes in bladder stone cutting, after giving the vulva disinfection, sterile voyeuristic exposed the vagina and cervix, after regular disinfecting vagina and cervix, then hand pressure at the bottom of the uterus, with a sterile syringe without a needle extract amniotic fluid about 3ml from the opening of the cervix flowing, these samples were centrifuged for 5 min and the supernatant was collected and stored at-70 ? low temperature refrigerator to detect amniotic fluid concentration of IL-6.3. Patients with premature rupture of membranes in childbirth, take a break of about 4*5 cm in size membranes for pathology examination. Grouped according to the clinical characteristics and pathologic findings, divided into three groups: clinical chorioamnionitis, subclinical chorioamnionitis and non-chorioamnionitis. Comparing two groups of patients with chorioamnionitis and non-chorioamnionitis in patients with clinical detection index. The interval between rupture of the membranes and the onset of labor is called latency, and we will record the period of latency for all patients.4. Using Graphpad PrismS.0 software and SPSS19.0 statistical software for the above results for statistical processing and analysis its significance.Results1. Experimental group of pregnant women serum WBC, CRP, IL-6 and IL-6 in the amniotic fluid levels were significantly higher than that of control group, difference has statistical significance(p<0.05).2. In the experimental group, the clinical chorioamnionitis, subclinical chorionic amniotic membrane inflammation and chorionic amniotic infection of pregnant women, by comparison of the latency time between any two groups, difference have statistical significance. Experimental group incorporating clinical chorioamnionitis, subclinical chorioamnionitis of pregnant women, the WBC, CRP in serum, IL-6 and IL-6 in the amniotic fluid levels were significantly higher than that of unincorporated chorioamnionitis of pregnant women, differences were statistically significant(P<0.05).3. In the serum of pregnant women, the WBC, CRP, IL-6 of the area under the ROC curve (AUC) are: 0.762,0.762,0.923, so the serum IL-6 had a significant meaning to determine chorioamnionitis (P= 0.045).Conclusions1. The levels of WBC, CRP, IL-6 in pregnant women serum and amniotic fluid IL 6 have close correlation with premature rupture of membranes, so we can presume these inflammatory cells and inflammatory factors play a certain role in the process of the occurrence of premature rupture of membranes.2. Pregnant women the WBC, CRP, IL-6 in serum and amniotic fluid IL-6 levels of detection for premature rupture of membranes combined chorioamnionitis has certain predictive value. And the severity of chorioamnionitis has close correlation with the length of the latency time.3. Pregnant women serum IL-6 detection for early diagnosis of premature rupture of membranes combined chorionic amniotic infection had a higher sensitivity and specificity. |
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