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Original Article

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Roberto Romero1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;2 Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA, ;3 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA, Correspondence[email protected] [email protected]

Jezid Miranda1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Tinnakorn Chaiworapongsa1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Piya Chaemsaithong1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Francesca Gotsch1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;5 Integrata Verona, Ostetricia Ginecologia, Azienda Ospedaliera Universitaria, Verona, Italy,

Zhong Dong1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Ahmed I. Ahmed1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Bo Hyun Yoon6 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,

Sonia S. Hassan1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Chong J. Kim1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;7 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, and

Steven J. Korzeniewski1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;3 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Lami Yeo1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;4 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,

Yeon Mee Kim1 Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD andDetroit, MI, USA, ;8 Department of Pathology, College of Medicine Inje University, Haeundae Paik Hospital, Busan, Democratic People's Republic of KoreaCorrespondence[email protected] [email protected]

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Figures & data

Table 1. Demographic and clinical characteristics of the study population.

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Table 2. Inflammatory markers in amniotic fluid, pregnancy outcomes and placental pathology results of patients in whom microorganisms were detected in amniotic fluid using standard cultivation techniques vs. PCR/ESI-MS.

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Table 3. Frequency of intra-amniotic inflammation and clinical outcome in asymptomatic patients with a sonographic short cervix before 24 weeks of gestation according to the results of PCR/ESI-MS, AF cultures and AF interleukin-6 concentrations.

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Figure 1. Kaplan–Meier survival curves of amniocentesis-to-delivery interval (days) among asymptomatic patients diagnosed with a CL ≤25 mm, according to the presence of microbial-associated or sterile intra-amniotic inflammation. Patients in whom labor was induced were censored and are represented by crosses. The amniocentesis-to-delivery interval among women with sterile intra-amniotic inflammation was significantly shorter than that of: (1) women without intra-amniotic inflammation; and (2) women with MIAC [median 35, (IQR: 10–70) versus median 71, (IQR: 47–98) days, and median 79, (IQR: 51–99) days (p < 0.001 and p = 0.02), respectively]. There was no significant difference in the amniocentesis-to-delivery interval between patients with sterile intra-amniotic inflammation and those with microbial-associated intra-amniotic inflammation (p > 5).

Table 4. Magnitude of association between type of intra-amniotic inflammation and risk of spontaneous preterm delivery at <34 weeks of gestation both unrestricted and restricted to patients whose diagnosis of a sonographic short cervix was performed <24 weeks of gestation.

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Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Table 1. Demographic and clinical characteristics of the study population.

Table 2. Inflammatory markers in amniotic fluid, pregnancy outcomes and placental pathology results of patients in whom microorganisms were detected in amniotic fluid using standard cultivation techniques vs. PCR/ESI-MS.

Table 3. Frequency of intra-amniotic inflammation and clinical outcome in asymptomatic patients with a sonographic short cervix before 24 weeks of gestation according to the results of PCR/ESI-MS, AF cultures and AF interleukin-6 concentrations.

Table 4. Magnitude of association between type of intra-amniotic inflammation and risk of spontaneous preterm delivery at <34 weeks of gestation both unrestricted and restricted to patients whose diagnosis of a sonographic short cervix was performed <24 weeks of gestation.

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Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Figures & data

Table 1. Demographic and clinical characteristics of the study population.

Table 2. Inflammatory markers in amniotic fluid, pregnancy outcomes and placental pathology results of patients in whom microorganisms were detected in amniotic fluid using standard cultivation techniques vs. PCR/ESI-MS.

Table 3. Frequency of intra-amniotic inflammation and clinical outcome in asymptomatic patients with a sonographic short cervix before 24 weeks of gestation according to the results of PCR/ESI-MS, AF cultures and AF interleukin-6 concentrations.

Table 4. Magnitude of association between type of intra-amniotic inflammation and risk of spontaneous preterm delivery at <34 weeks of gestation both unrestricted and restricted to patients whose diagnosis of a sonographic short cervix was performed <24 weeks of gestation.

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