The antibiotic treatment of PPROM study: systemic maternal and fetal markers and perinatal outcomes

• Published in: American journal of obstetrics and gynecology Vol. 206; no. 2; pp. 145.e1 - 145.e9
• Main Authors: Mercer, Brian M., MD, Crouse, Dennis T., MD, Goldenberg, Robert L., MD, Miodovnik, Menachem, MD, Mapp, Delicia C., MS, Meis, Paul J., MD, Dombrowski, Mitchell P., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2012; Elsevier
• Subjects: Adult; Amoxicillin - therapeutic use; Ampicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; cytokines; Cytokines - blood; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Erythromycin - therapeutic use; Female; Fetal Blood; Fetal Membranes, Premature Rupture - blood; Fetal Membranes, Premature Rupture - drug therapy; granulocyte colony-stimulating factor; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; intercellular adhesion molecule-1; Intercellular Adhesion Molecule-1 - blood; Medical sciences; Obstetrics and Gynecology; Pharmacology. Drug treatments; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; premature rupture of membranes; Randomized Controlled Trials as Topic; tumor necrosis factor-α; cytokines; granulocyte colony-stimulating factor; tumor necrosis factor-α; premature rupture of membranes; intercellular adhesion molecule-1; Prognosis; Pregnancy disorders; Gynecology; Premature rupture of membrane; Perinatal; Systemic; Marker; Obstetrics; Pregnancy; Antibiotic; Treatment; Mother; Delivery disorders; Fetus; Disseminated; Antibacterial agent
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2011.08.028

Objective We sought to correlate maternal and cord blood cytokine and intercellular adhesion molecule-1 levels with antibiotic exposure and perinatal outcomes after conservatively managed preterm premature rupture of the membranes. Study Design Conservatively managed women with preterm premature rupture of the membranes at 24-32 weeks had blood sampling at randomization (n = 222) and delivery (n = 121). Plasma from these, and umbilical cord blood (n = 196), was stored at –70°C. Interleukin (IL)-6, IL-10, granulocyte colony-stimulating factor (G-CSF), tumor necrosis factor-α, and intercellular adhesion molecule-1 levels were assessed for associations with antibiotic treatment, latency, amnionitis, neonatal sepsis, pneumonia, and composite neonatal morbidity. Results Cord blood IL-6 and G-CSF were higher than maternal levels. Antibiotic treatment lowered only maternal G-CSF ( P = .01). Elevated maternal cytokine levels were associated with delivery within 7 days and with development of chorioamnionitis. All umbilical cord blood markers were increased with amnionitis ( P ≤ .01 for each). No maternal marker was associated with neonatal morbidities. Cord G-CSF and IL-6 were increased with neonatal sepsis within 72 hours of birth ( P = .004 for both), and with composite neonatal morbidity ( P = .001 and .002, respectively). Maternal and umbilical cord cytokine levels demonstrated low predictive values for perinatal outcomes. Conclusion Umbilical cord blood cytokine values are higher than maternal levels, suggesting significant fetal/placental contribution. Maternal and umbilical cord cytokine levels are not adequately predictive to be used clinically.