The relationship between amniotic fluid tumor necrosis factor- , histologic chorioamnionitis, and congenital sepsis in preterm labor

Park, Kyo Hoon; Yoon, Bo Hyun; Jun, Jong Kwan; Park, Joong Shin; Kim, Gil Ja; Lee, Hong Kyoon; Syn, Hee Chul

Abstract

OBJECTIVE
Our purposes were (1) to determine whether amniotic fluid concentrations of tumor necrosis factor- are of value in the diagnosis of histologic chorioamnionitis of preterm placenta and in the prediction of congenital sepsis in patients with preterm labor and intact membranes and (2) to compare the diagnostic performance of placental histologic finding and amniotic fluid culture with that of amniotic fluid tumor necrosis factor- for this outcome variable.
METHODS
The relations among placental histologic finding, perinatal outcome, amniotic fluid culture, and amniotic fluid tumor necrosis factor- concentrations were examined in 61 consecutive patients with preterm labor and intact membranes who delivered preterm neonates within 72 hours after transabdominal amniocentesis. Tumor necrosis factor- was determined by enzyme-linked immunosorbent assays. Mann-Whitney U test, Fisher's exact test, receiver-operator characteristic curve, and multiple logistic regression were used for analysis.
RESULTS
1) Women with acute histologic chorioamnionitis had significantly higher median amniotic fluid tumor necrosis factor- concentrations than those without histologic chorioamnionitis (median 83.2 pg/ml, range 1.4 to 7241 pg/ml vs median 1.6 pg/ml, range 0 to 59.9 pg/ml, p <0.0001). Amniotic fluid tumor necrosis factor- concentrations > or =4.6 pg/ml had a sensitivity of 88% (28/32) and specificity of 80% (23/29) in the diagnosis of acute histologic chorioamnionitis. 2) Amniotic fluid concentrations of tumor necrosis factor- were significantly higher in neonates with congenital sepsis than in those without congenital sepsis (median 227.5 pg/ml, range 1.2 to 7241 pg/ml vs median 3.8 pg/ml, range 0 to 735 pg/ml, p <0.0005). Amniotic fluid tumor necrosis factor- concentrations > or =41 pg/ml had a sensitivity of 82% (23/29) and specificity of 79% (38/48) in the prediction of congenital sepsis. 3) Multiple logistic regression indicated that elevated amniotic fluid tumor necrosis factor- (> or =41 pg/ml) was the only independent predictor of congenital sepsis (odd ratio 12.9, 95% confidence interval 1.3 to 125.3, p<0.05) after correction for known confounding variables [i.e., low gestational age at birth (< or =32 weeks), positive amniotic fluid culture, histologic or clinical chorioamnionitis, low Apgar score (<7)].
CONCLUSION
Test of amniotic fluid tumor necrosis factor- is of value in the antenatal diagnosis of histologic chorioamnionitis and congenital sepsis in patients with preterm labor and intact membranes. Amniotic fluid tumor necrosis factor- is a better independent predictor of congenital sepsis than placental histologic finding or amniotic fluid culture.