Comprehensive amniotic fluid cytokine profile evaluation in women with a short cervix: which cytokine(s) correlates best with outcome?
Presented at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.
Received 28 February 2009; received in revised form 27 April 2009; accepted 22 May 2009.
Objective
The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester.
Study Design
Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length ≤25 mm. Amniotic fluid from patients who received no surgical or hormonal treatment was assayed for 25 cytokines. Univariate analysis identified cytokine(s) that correlated with the interval between amniocentesis to delivery. Stepwise regression identified which cytokine(s) was most predictive of delivery, followed by the generation of receiver-operator characteristic curves. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
Results
Forty-four amniotic fluid samples were analyzed. After stepwise regression, only monocyte chemotactic protein-1 remained significant and was the most predictive of early delivery. With a cutoff of 1320 pg/mL, monocyte chemotactic protein-1 had a 69% sensitivity, 83% specificity, 36% positive predictive value, and 87% negative predictive value to predict spontaneous preterm birth within 1 week of amniocentesis (P = .015).
Conclusion
Among 25 cytokines, monocyte chemotactic protein-1 was most predictive of spontaneous preterm birth.
aDepartment of Obstetrics and Gynecology, New York University Medical Center, New York, NY
bDepartment of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA
cDepartment of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY
dDepartment of Pediatrics, Winthrop University Hospital, Mineola, NY
eDepartment of Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook University Medical Center, Stony Brook, NY
fDepartment of Obstetrics and Gynecology, Mercy Medical Center, Baltimore, MD
Reprints not available from the authors.
This study was supported by the Department of Obstetrics and Gynecology, Lehigh Valley Health Network, and the Department of Pediatrics, Winthrop University Hospital.
Cite this article as: Keeler SM, Kiefer DG, Rust OA, et al. Comprehensive amniotic fluid cytokine profile evaluation in women with a short cervix: which cytokine(s) correlates best with outcome? Am J Obstet Gynecol 2009;201:276.e1-6.
ABSTRACT