Abstract
Introduction
The aim of this study was to determine the diagnostic performance of different diagnostic
tests for histologic chorioamnionitis in patients at more than 20 weeks of gestation.
Methods
A systematic search was carried out through MEDLINE, EMBASE, LILACS, CENTRAL and unpublished
literature. Observational studies included with pregnant women (>20 weeks) with chorioamnionitis.
The reference standard was the histopathological study of the placenta, umbilical
cord and fetal membranes. Two independent researchers extracted data and performed
a meta-analysis of diagnostic tests.
Results
Twenty-nine articles were included. The studies provided evidence in the form of maternal
clinical and serological tests; tests of vaginal fluid, amniotic fluid or the umbilical
cord; fetal monitoring and ultrasound tests. To assess the performance of maternal
serum CRP, 13 studies were included, showing a combined sensitivity of 68.7% (95%CI
58%–77%) and a combined specificity of 77.1% (95%CI 67%–84%). Maternal leukocytosis
was evaluated in four publications, showing a combined sensitivity of 51% (95%CI 40%–62%)
and a combined specificity of 65% (95%CI 50%–78%).
Conclusions
CRP and maternal leukocytosis, showed a low sensitivity and specificity. The sonographic
evaluation of the fetal thymus is also more sensitive for the diagnosis of histologic
chorioamnionitis than the fetal biophysical profile.
Keywords
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References
- Prématurité et infection: état des connaissances.J Gynecol Obstet Biol la Reprod Elsevier Masson SAS. 2012; 41: 14-25
- Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques.J Perinat Med. 2015; 43: 19-36
- Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns.Pediatr Dev Pathol. 2003; 6: 435-438
- Proteómica clínica y nuevos biomarcadores en los líquidos biológicos.Med Clin. 2008; 131: 426-434
- Amniotic fluid concentrations of matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 during pregnancy and labor.Am J Obstet Gynecol. 2001; 184: 159-164
- Amniotic fluid analysis. Part I: rapid markers in the prediction of intra-amniotic infection.Ginekol Pol. 2005; 76: 77-84
- Guide to the contents of a cochrane diagnostic test accuracy protocol.Cochrane handbook for systematic reviews of diagnostic test accuracy version 100. 2013: 1-15
- Systematic reviews of adverse effects: framework for a structured approach.BMC Med Res Methodol. 2007; 7 ([Internet]. Jan [cited 2013 Dec 26], Available from:): 32
- Fundamentos de medicina basada en la evidencia: Listas guía de comprobación de estudios sobre pruebas diagnósticas incluidos en las revisiones sistemáticas: declaración QUADAS.Evid Pediatr. 2012; 8: 1-6
- Cochrane handbook for systematic reviews of interventions version 5.1.0.([Internet] Available from:) The Cochrane Collaboration, 2011www.cochrane-handbook.org
- Cochrane diagnostic test accuracy reviews.Syst Rev Syst Rev. 2013; 2: 82
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes | read by QxMD.J Obstet Gynaecol Res. 2014; 40: 954-960
- Interleukin-8 level in maternal serum as a marker for screening of histological chorioamnionitis at term.Int J Gynecol Obstet. 1997; 57: 153-159
- Assessment of predictive markers for placental inflammatory response in preterm births.PLoS One. 2014; 9
- Maternal plasma interleukin-6, interleukin-1beta and C-reactive protein as indicators of tocolysis failure and neonatal outcome after preterm delivery.J Matern Fetal Neonatal Med. 2007; 20: 335-341
- Moawad a H. The significance of C-reactive protein levels in women with premature rupture of membranes.Am J Obstet Gynecol. 1985; 151: 541-544
- Serum intercellular adhesion molecule-1 levels and histologic chorioamnionitis.Obstet Gynecol. 2000; 95: 671-676
- Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity.Am J Obstet Gynecol. 1995; 172: 960-970
- Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study.BMC Pregnancy Childbirth BioMed Central Ltd. 2011; 11: 1-9
- Accurate prediction of the stage of histological chorioamnionitis before delivery by amniotic fluid IL-8 level.Am J Reprod Immunol. 2015; 73: 568-576
- Accuracy of signs of clinical chorioamnionitis in the term parturient.J Perinatol Nat Publ Group. 2013; 33: 422-428
- The value of cord blood interleukin-6 levels for predicting chorioamnionitis, funisitis and neonatal infection in term premature rupture of membranes.Eur J Obstet Gynecol Reprod Biol. 2006; 128: 34-39
- Procalcitonin for prediction of chorioamnionitis in preterm premature rupture of membranes procalcitonin for prediction of chorioamnionitis in preterm premature rupture of membranes.J Matern Neonatal Med. 2016; 29: 2056-2061
- The antenatal identification of funisitis with a rapid MMP-8 bedside test.J Perinat Med. 2008; 36: 497-502
- A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes: analyses of multiple proteins in the amniotic fluid.J Matern Fetal Neonatal Med. 2012; 25: 1995-2001
- Maternal serum interleukin-6 levels predict impending funisitis in preterm premature rupture of membranes after completion of antibiotics.J Matern Neonatal Med. 2012; 25: 1329-1332
- Neutrophil granule products: can they identify subclinical chorioamnionitis in patients with preterm premature rupture of membranes?.Am J Obstet Gynecol. 2003; 189: 808-812
- Biophysical profile in predicting acute ascending infection in preterm rupture of membranes before 32 weeks.Obstet Gynecol. 2000; 96: 201-206
- Relationship of amniotic fluid markers of intra-amniotic infection with histopathology in cases of preterm labor with intact membranes.J Perinatol. 1999; 19: 407-412
- Fetal breathing movements within 24 h of delivery in prematurity are related to histologic and clinical evidence of amnionitis.Am J Perinatol. 1997; 14: 337-340
- Neutrophil attractant/activating peptide-1/interleukin-8: association with histologic chorioamnionitis, preterm delivery, and bioactive amniotic fluid leukoattractants.Am J Obstet Gynecol. 1993; 169: 1299-1303
- Bedside assessment of amniotic fluid interleukin-6 in preterm prelabor rupture of membranes.Am J Obstet Gynecol. 2014; 211 (Elsevier Inc., e1-385.e9): 385
- Fetal tyhmus size as a predictor of histological chorioamnionitis in preterm premature rupture of membranes.J Matern Fetal Neonatal Med. 2014; 27: 1118-1122
- Ultrasound measurement of the transverse diameter of the fetal thymus in pregnancies complicated by the preterm prelabor rupture of membranes.J Clin Ultrasound. 2013; 41: 283-289
- Chorioamnionitis and diagnostic value of C-reactive protein, erythrocyte sedimentation rate and white blood cell count in its diagnosis among pregnant women with premature rupture of membranes.Pak J Biol Sci. 2012; 15: 454-458
- Maternal C-reactive protein at hospital admission is a simple predictor of funisitis in preterm premature rupture of membranes.Gynecol Obstet Invest. 2012; 74: 95-99
- Relationship between maternal serum C-reactive protein, funisitis and early-onset neonatal sepsis.J Korean Med Sci. 2012; 27: 674-680
- Predictive value of intra-amniotic and serum markers for inflammatory lesions of preterm placenta.Placenta. 2011; 32: 732-736
- Funisitis and chorionic vasculitis: the histological counterpart of the fetal inflammatory response syndrome.J Matern Fetal Neonatal Med. 2002; 11: 18-25
- Is C-reactive protein really useful in preterm premature rupture of the membranes?.Br J Obstet Gynaecol. 1987; 94: 1159-1164
- Fetal thymus size as a predictor of chorioamnionitis in women with preterm premature rupture of membranes.Ultrasound Obstet Gynecol. 2007; 29: 639-643
- The value of the genedia MMP-8 rapid test for diagnosing intraamniotic infection/inflammation and predicting adverse pregnancy outcomes in women with preterm premature rupture of membranes.Am J Obstet Gynecol. 2015; 212 (Elsevier Inc.): S174
- Procalcitonin for assessment of chorioamniotis in preterm premature rupture of membranes.Am J Obstet Gynecol. 2011; 204 (Elsevier Inc.): S187
- A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes.Am J Obstet Gynecol. 1993; 169: 839-851
Article info
Publication history
Published online: June 09, 2018
Accepted:
May 31,
2018
Received in revised form:
May 29,
2018
Received:
March 7,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
