American Journal of Obstetrics & Gynecology
Volume 202, Issue 5 , Pages 433.e1-433.e8, May 2010

Patients with an asymptomatic short cervix (≤15 mm) have a high rate of subclinical intraamniotic inflammation: implications for patient counseling

Presented at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010.

  • Edi Vaisbuch, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Sonia S. Hassan, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Shali Mazaki-Tovi, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Chia-Ling Nhan-Chang, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Juan Pedro Kusanovic, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Tinnakorn Chaiworapongsa, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Zhong Dong, PhD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • ,
  • Lami Yeo, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Pooja Mittal, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
    • ,
  • Bo Hyun Yoon, MD, PhD

      Affiliations

    • Department of Obstetrics and Gynecology, Seoul National University College of Medicine, and the Laboratory of Fetal Medicine Research, Clinical Research Institute, Seoul National University, Seoul, Korea
    • ,
  • Roberto Romero, MD

      Affiliations

    • Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
    • Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
    • Corresponding Author InformationReprints: Roberto Romero, MD, Perinatology Research Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Wayne State University/Hutzel Women's Hospital, 3990 John R, Box 4, Detroit, MI 48201

Received 8 September 2009; received in revised form 19 November 2009; accepted 2 February 2010.

Objective

The objective of the study was to determine the frequency and clinical significance of intraamniotic inflammation in asymptomatic women with a sonographic short cervix (SCX) in the midtrimester.

Study Design

This cohort study included 47 asymptomatic women (14-24 weeks) with an SCX (≤15 mm) who underwent amniocentesis. Women with multiple gestation, cerclage, or cervical dilatation greater than 2 cm were excluded. Intraamniotic inflammation was defined as an elevated amniotic fluid (AF) matrix metalloproteinase-8 concentration (>23 ng/mL).

Results

(1) intraamniotic infection was found in 4.3% of patients; (2) among patients with a negative AF culture, the prevalence of intraamniotic inflammation was 22.2%; and (3) patients with a negative AF culture, but with intraamniotic inflammation, had a higher rate of delivery within 7 days (40% vs 5.7%; P = .016) and a shorter median diagnosis-to-delivery interval than those without intraamniotic inflammation (18 vs 42 days; P = .01).

Conclusion

Twenty-two percent of patients with a midtrimester SCX have intraamniotic inflammation. The risk of preterm delivery within 7 days for these patients is 40%.

Key words: cervical length, intraamniotic inflammation, matrix metalloproteinase-8, MMP-8, pregnancy, prematurity, preterm delivery

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 Cite this article as: Vaisbuch E, Hassan SS, Mazaki-Tovi S, et al. Patients with an asymptomatic short cervix (≤15 mm) have a high rate of subclinical intraamniotic inflammation: implications for patient counseling. Am J Obstet Gynecol 2010;202:433.e1-8.

 This study was supported in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services.

PII: S0002-9378(10)00212-7

doi:10.1016/j.ajog.2010.02.007

American Journal of Obstetrics & Gynecology
Volume 202, Issue 5 , Pages 433.e1-433.e8, May 2010

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