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Amniotic fluid interleukin-8, l-selectin, fas and fas ligand in intraamniotic infection
S62 SMFM Abstracts 193
NEONATAL OUTCOME FOLLOWING CONSERVATIVE MANAGEMENT OF PPROM AMONG HIV INFECTED PATIENTS BRENDA ROSS1, SONGHAI BARCLIFF1, HAROLD FOX1, JEAN ANDERSON1, 1Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: To assess the risk of neonatal sepsis and vertical transmission of HIV among infants born to HIV positive mothers following premature preterm spontaneous rupture of the membranes. STUDY DESIGN: To determine if pPROM among HIV positive patients increased the risk of infectious morbidity among their infants we conducted a retrospective review of the deliveries to HIV positive patients at our institution between 1996 and 2003 and identified the 15 cases complicated by pPROM. We examined the neonatal outcomes among the infants born to these patients. RESULTS: Of the 196 deliveries among HIV positive patients, 15 patients presented at less than 37 weeks gestation with pPROM. The gestational ages ranged from 24 3/7 wks to 36 6/7 wks. The latency period ranged from several hours to 4 weeks. All of the patients with pPROM were treated with prophylactic antibiotics and those at less than 32 wks were given corticosteroids to accelerate fetal lung maturation. 12 of the 15 patients were treated with intrapartum AZT. At the time of admission, 5/15 patients were on HAART, 6/ 15 were on AZT alone and the remaining four patients had not taken any ARV’s. The CD4 counts ranged from 65-892 copies/ml and the viral loads ranged from less than 50 to 165,718. Among the patients with pPROM there was one case of neonatal sepsis and one episode of vertical transmission, different infants. CONCLUSION: Preterm premature spontaneous rupture of the membranes is one of the most common causes of preterm delivery. There is little information about appropriate management among HIV infected patients. Although our data is limited, we saw no significant increase in vertical transmission or other complications among neonates born to HIV infected women with pPROM who were managed expectantly.
195
AMNIOTIC FLUID INTERLEUKIN-8, L-SELECTIN, FAS AND FAS LIGAND IN INTRAAMNIOTIC INFECTION CHAUR-DONG HSU1, ALEKSANDR FUKS1, SATYA POLAVARAPU1, 1New York Medical College - Westchester Medical Center, Obstetrics and Gynecology, Valhalla, New York OBJECTIVE: Our purpose was to compare and correlate amniotic fluid interleukin-8 (IL-8), soluble L-selectin (sL-selectin), Fas (sFas) and Fas ligand (sFasL) in patients with and without intraamniotic infection. STUDY DESIGN: Amniocentesis was performed on 81 singleton pregnant women with preterm contractions, labor, or rupture of membranes. Twenty-five patients had intraamniotic infection, and 56 did not. Intraamniotic infection was defined as the presence of a positive amniotic fluid culture. Amniotic fluid neutrophil counts were determined. Amniotic fluid levels of IL-8, sL-selectin, sFas, sFasL were measured by an enzyme-linked immunoassay. Student’s t test and Pearson correlation coefficient were used for statistical analysis. Data were expressed as mean G SEM. RESULTS: There were no significant differences in maternal age, gestational age, race or parity between two groups. Amniotic fluid mean levels of IL-8, sLselectin, sFas, and sFasL were significantly higher in pregnant women with intraamniotic infection than in those without intraamniotic infection (IL-8: 90.1 G 12.7 ng/mL vs. 5.0 G 1.1 ng/mL, P ! .0001; sL-selectin: 42 G 7.3 ng/mL vs. 20.0 G 1.8 ng/mL, P = .0002; sFas: 5.37 G 0.65 U/mL vs. 2.02 G 0.21 U/mL, P ! .0001; sFasL: 0.39 G 0.05 ng/mL vs. 0.29 G 0.02 ng/mL, P = .01). Patients with intraamniotic infection had significantly higher amniotic fluid leukocyte counts compared to those without intraamniotic infection. Amniotic fluid IL-8, sL-selectin, sFas, and sFasL were positively correlated, and each was positively correlated with amniotic fluid leukocytes. CONCLUSION: Our data indicate that amniotic fluid IL-8 is a potent leukocyte chemoattractant and activator, and L-selectin is rapidly shed from apoptotic leukocytes in the amniotic fluid in patients with intraamniotic infection.
194
PENTRAXIN (PTX)-3 IN PRETERM LABOR AND PREMATURE RUPTURE OF MEMBRANES (PROM): A MARKER OF INTRAUTERINE INFECTION? CLAUDIA BONARDI1, FRANCESCA ASSI1, ANNA LOCATELLI1, ALESSANDRO GHIDINI2, CECILIA GARLANDA3, ALBERTO MANTOVANI3, 1University of Milano-Bicocca, Obstetrics and Gynecology, Monza, Italy, Italy, 2Georgetown University, Obstetrics and Gynecology, Washington, District of Columbia, 3Istituto Mario Negri, Milano, Italy, Italy OBJECTIVE: PTX-3 is a non-redundant acute-phase protein produced by macrophages and monocytes, among other cells, in response to primary inflammatory signals, including interleukin-1, tumor necrosis factor, and lipopolysaccharide. We have made the novel observation that serum and vaginal concentrations of PTX-3 are elevated in women with preterm labor or PROM, two conditions in which activation of inflammatory signals due to infection play an important role. We have thus evaluated whether PTX3 is a marker of infectious outcome. STUDY DESIGN: From 12/2002 to 6/2004 we have serially assessed the serum and vaginal concentrations of PTX3 in consecutive patients with preterm PROM (n = 27) or preterm labor with intact membranes (n = 13). Concentration of PTX3 was determined by use of immunoassays. We compared the last PTX3 concentrations in patients with vs without clinical or histologic evidence of intrauterine infection using Wilcoxon rank-sum test, with P ! 0.05 considered significant. RESULTS: Mean gestational age at delivery was 31.2 weeks (range 22.6-33.6). The interval between last sampling and delivery was 1.5 (0-7) and 1 (0-9) days in the group with vs without intrauterine infection, respectively. Median (range) serum PTX3 concentrations at the last sampling before delivery were not significantly different in the two groups [702 (0-9630) vs 599 (0-2970) pg/ml respectively, P = .88]. Similarly, median (range) vaginal PTX3 concentrations were not significantly higher among women with intrauterine infection that in those without [523 (0-6604) vs 1520 (0-3160) pg/ml respectively, P = .44]. CONCLUSION: Although PTX-3 is elevated in maternal serum and vaginal concentrations of women with PTL or PROM, it does not signal intrauterine infection. Given that PTX3 also suppresses neovascularization and enhances tissue factor activity, we hypothesize that PTX-3 elevations in PTL and PROM may be related to clotting activation.
196
WITHDRAWN
NEONATAL OUTCOME FOLLOWING CONSERVATIVE MANAGEMENT OF PPROM AMONG HIV INFECTED PATIENTS BRENDA ROSS1, SONGHAI BARCLIFF1, HAROLD FOX1, JEAN ANDERSON1, 1Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: To assess the risk of neonatal sepsis and vertical transmission of HIV among infants born to HIV positive mothers following premature preterm spontaneous rupture of the membranes. STUDY DESIGN: To determine if pPROM among HIV positive patients increased the risk of infectious morbidity among their infants we conducted a retrospective review of the deliveries to HIV positive patients at our institution between 1996 and 2003 and identified the 15 cases complicated by pPROM. We examined the neonatal outcomes among the infants born to these patients. RESULTS: Of the 196 deliveries among HIV positive patients, 15 patients presented at less than 37 weeks gestation with pPROM. The gestational ages ranged from 24 3/7 wks to 36 6/7 wks. The latency period ranged from several hours to 4 weeks. All of the patients with pPROM were treated with prophylactic antibiotics and those at less than 32 wks were given corticosteroids to accelerate fetal lung maturation. 12 of the 15 patients were treated with intrapartum AZT. At the time of admission, 5/15 patients were on HAART, 6/ 15 were on AZT alone and the remaining four patients had not taken any ARV’s. The CD4 counts ranged from 65-892 copies/ml and the viral loads ranged from less than 50 to 165,718. Among the patients with pPROM there was one case of neonatal sepsis and one episode of vertical transmission, different infants. CONCLUSION: Preterm premature spontaneous rupture of the membranes is one of the most common causes of preterm delivery. There is little information about appropriate management among HIV infected patients. Although our data is limited, we saw no significant increase in vertical transmission or other complications among neonates born to HIV infected women with pPROM who were managed expectantly.
195
AMNIOTIC FLUID INTERLEUKIN-8, L-SELECTIN, FAS AND FAS LIGAND IN INTRAAMNIOTIC INFECTION CHAUR-DONG HSU1, ALEKSANDR FUKS1, SATYA POLAVARAPU1, 1New York Medical College - Westchester Medical Center, Obstetrics and Gynecology, Valhalla, New York OBJECTIVE: Our purpose was to compare and correlate amniotic fluid interleukin-8 (IL-8), soluble L-selectin (sL-selectin), Fas (sFas) and Fas ligand (sFasL) in patients with and without intraamniotic infection. STUDY DESIGN: Amniocentesis was performed on 81 singleton pregnant women with preterm contractions, labor, or rupture of membranes. Twenty-five patients had intraamniotic infection, and 56 did not. Intraamniotic infection was defined as the presence of a positive amniotic fluid culture. Amniotic fluid neutrophil counts were determined. Amniotic fluid levels of IL-8, sL-selectin, sFas, sFasL were measured by an enzyme-linked immunoassay. Student’s t test and Pearson correlation coefficient were used for statistical analysis. Data were expressed as mean G SEM. RESULTS: There were no significant differences in maternal age, gestational age, race or parity between two groups. Amniotic fluid mean levels of IL-8, sLselectin, sFas, and sFasL were significantly higher in pregnant women with intraamniotic infection than in those without intraamniotic infection (IL-8: 90.1 G 12.7 ng/mL vs. 5.0 G 1.1 ng/mL, P ! .0001; sL-selectin: 42 G 7.3 ng/mL vs. 20.0 G 1.8 ng/mL, P = .0002; sFas: 5.37 G 0.65 U/mL vs. 2.02 G 0.21 U/mL, P ! .0001; sFasL: 0.39 G 0.05 ng/mL vs. 0.29 G 0.02 ng/mL, P = .01). Patients with intraamniotic infection had significantly higher amniotic fluid leukocyte counts compared to those without intraamniotic infection. Amniotic fluid IL-8, sL-selectin, sFas, and sFasL were positively correlated, and each was positively correlated with amniotic fluid leukocytes. CONCLUSION: Our data indicate that amniotic fluid IL-8 is a potent leukocyte chemoattractant and activator, and L-selectin is rapidly shed from apoptotic leukocytes in the amniotic fluid in patients with intraamniotic infection.
194
PENTRAXIN (PTX)-3 IN PRETERM LABOR AND PREMATURE RUPTURE OF MEMBRANES (PROM): A MARKER OF INTRAUTERINE INFECTION? CLAUDIA BONARDI1, FRANCESCA ASSI1, ANNA LOCATELLI1, ALESSANDRO GHIDINI2, CECILIA GARLANDA3, ALBERTO MANTOVANI3, 1University of Milano-Bicocca, Obstetrics and Gynecology, Monza, Italy, Italy, 2Georgetown University, Obstetrics and Gynecology, Washington, District of Columbia, 3Istituto Mario Negri, Milano, Italy, Italy OBJECTIVE: PTX-3 is a non-redundant acute-phase protein produced by macrophages and monocytes, among other cells, in response to primary inflammatory signals, including interleukin-1, tumor necrosis factor, and lipopolysaccharide. We have made the novel observation that serum and vaginal concentrations of PTX-3 are elevated in women with preterm labor or PROM, two conditions in which activation of inflammatory signals due to infection play an important role. We have thus evaluated whether PTX3 is a marker of infectious outcome. STUDY DESIGN: From 12/2002 to 6/2004 we have serially assessed the serum and vaginal concentrations of PTX3 in consecutive patients with preterm PROM (n = 27) or preterm labor with intact membranes (n = 13). Concentration of PTX3 was determined by use of immunoassays. We compared the last PTX3 concentrations in patients with vs without clinical or histologic evidence of intrauterine infection using Wilcoxon rank-sum test, with P ! 0.05 considered significant. RESULTS: Mean gestational age at delivery was 31.2 weeks (range 22.6-33.6). The interval between last sampling and delivery was 1.5 (0-7) and 1 (0-9) days in the group with vs without intrauterine infection, respectively. Median (range) serum PTX3 concentrations at the last sampling before delivery were not significantly different in the two groups [702 (0-9630) vs 599 (0-2970) pg/ml respectively, P = .88]. Similarly, median (range) vaginal PTX3 concentrations were not significantly higher among women with intrauterine infection that in those without [523 (0-6604) vs 1520 (0-3160) pg/ml respectively, P = .44]. CONCLUSION: Although PTX-3 is elevated in maternal serum and vaginal concentrations of women with PTL or PROM, it does not signal intrauterine infection. Given that PTX3 also suppresses neovascularization and enhances tissue factor activity, we hypothesize that PTX-3 elevations in PTL and PROM may be related to clotting activation.
196
WITHDRAWN