Amniotic fluid inflammation with negative culture and outcome after cervical cerclage

Abstract

Objective: To determine whether amniotic fluid (AF) inflammation, in the absence of infection, is associated with adverse pregnancy outcomes in nonelective cervical cerclage patients. Methods: A retrospective case-control study was carried out. The patient population included 82 singleton pregnancies with negative AF cultures. The variables used to define AF inflammation were white blood cell count (WBC) >50 cell/mm³, glucose <14 mg/dl or interleukin-6 (IL-6) >11.3 ng/ml. The study group consisted of cases with intra-amniotic inflammation. Sub-analysis was performed for the groups in which IL-6 concentrations were measured. Adverse outcomes were evaluated with variables such as gestational age at delivery, interval from cerclage to delivery, chorioamnionitis and cumulative neonatal morbidity. Results: Elevated AF WBC was correlated with severe and extreme preterm delivery (p < 0.05). Decreased AF glucose was associated with histological chorioamnionitis and a decreased cerclage to delivery interval (p < 0.05). Elevated AF IL-6 correlated significantly with decreased gestational age at delivery (p < 0.012) and decreased cerclage to delivery interval (p < 0.001). Elevated IL-6 concentrations were associated with severe, extreme preterm delivery (p < 0.001) and neonatal death (p < 0.001). Conclusion: Elevated AF IL-6, elevated WBC and low AF glucose, in the absence of a positive AF culture, are significantly associated with adverse pregnancy outcomes in patients undergoing nonelective cerclage.

Keywords::

• Rescue
• markers
• neonatal
• pregnancy
• nonelective

Acknowledgments

The authors thank the Perinatology Research Branch plus Faculty and Residents from the Department of Obstetrics and Gynecology at Wayne State University, who have helped with the collection of AF samples for more than 15 years.

Declaration of Interest: No financial support, supplies or services were obtained from a commercial organization. No funding was received from the National Institutes of Health or any other institute. The authors report no conflicts of interest.