Oligohydramnios in Preterm Prom is Associated with an Intense Amniotic , and Maternal Inflammatory Response but not with Fetal Hypoxia

Syn, Hee Chul; Kim, Young Ah

Abstract

OBJECTIVE
To examine the relationship of the amniotic, and maternal infiammatory responses and decreased amniotic fluid in patients with preterm PROM.
METHODS
Fifty three patients with preterm PROM in singleton pregnancy who delivered preterm neonates (gestational age<35 weeks) within 3 days of amniocentesis were included. Amniotic fluid index(AFI) was measured by transabdominal ultrasonography at amniocentesis. Amniotic fluid was cultured far aerobic and anaerobic bacteria and mycoplasma. The intensity of the inflammatory response was evaluated by clinical and histologic chorioamnionitis. The intensity of fetal hypoxia was evaluated by 1 min Apgar score, 5 min Apgar score, and pH of cord blood at birth.
RESULTS
The prevalence of oligohydramnios, which was defined when measured AFI was equal or less than 5.0, was 34% (18/53). The prevalence of positive amniotic fluid culture was 45% (24/53) and that of patients with was significantly higher than that of patients without oligohydramnios (78% [14/l8] vs 29% [10/35], p<0.01). Intrauterine inflammatory response was significantly stronger in patients with oligohydratnnios than in patients with adequate amniotic fluid (pathologic chorioamnionitis 100% [l6/16] vs 63% [19/30], clinical chorioamnionitis 39% [7/18] vs 6% [2/35]; p<0.01 for each). However, no significant difference was found in the intensity of fetal hypoxia (I min Apgar score <7 67% [12/18] vs 66% [23/35], 5 min Apgar score <7 39% [7/l8] vs 26% [9/35], pH of cord artery blood at birth 7.27+0.13 vs 7.22+0.13; p>O.I, for each).
CONCLUSION
Oligohydramnios in patients with preterm PROM is strongly pedictive for positive amniotic fluid culture, and is associated with a robust host response in amniotic, and maternal cornpartments, but not with fetal hypoxia.