Advertisement

Tumor necrosis factor in preterm and term labor

  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    ,
    Author Footnotes
    b Department of Obstetrics and Gynecology, Wayne State University
    Roberto Romero
    Correspondence
    Reprint requests: Roberto Romero, MD, Department of Obstetrics and Gynecology, Wayne State University, 4707 St. Antoine Blvd., Detroit, MI 48201.
    Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    b Department of Obstetrics and Gynecology, Wayne State University
    Search for articles by this author
  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    Moshe Mazor
    Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    Search for articles by this author
  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    ,
    Author Footnotes
    b Department of Obstetrics and Gynecology, Wayne State University
    Waldo Sepulveda
    Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    b Department of Obstetrics and Gynecology, Wayne State University
    Search for articles by this author
  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    Cecilia Avila
    Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    Search for articles by this author
  • Author Footnotes
    c Genzyme Corporation.
    Diane Copeland
    Footnotes
    c Genzyme Corporation.
    Search for articles by this author
  • Author Footnotes
    c Genzyme Corporation.
    John Williams
    Footnotes
    c Genzyme Corporation.
    Search for articles by this author
  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Yale University School of Medicine
    b Department of Obstetrics and Gynecology, Wayne State University
    c Genzyme Corporation.
      This paper is only available as a PDF. To read, Please Download here.
      Objective: Our objective was to determine if labor (term and preterm) and microbial invasion of the amniotic cavity were associated with changes in amniotic fluid concentrations of tumor necrosis factor.
      Study Design: Amniotic fluid was retrieved by transabdominal amniocentesis from 269 women in the following groups: midtrimester (n = 38), preterm labor with intact membranes (n = 52), preterm premature rupture of membranes (n = 74), term in active labor (n = 84), and term not in labor (n = 21). Fluid was cultured for aerobic and anaerobic bacteria and for Mycoplasma species. Tumor necrosis factor was measured with a commercially available enzyme-linked immunosorbent assay validated for amniotic fluid (sensitivity 60 pg/ml).
      Results: Amniotic fluid from pregnant women in the second and third trimesters who were not in labor did not contain tumor necrosis factor. Among women in preterm labor, 92.3% (12/13) of patients with a positive amniotic fluid culture had detectable tumor necrosis factor in the amniotic fluid (median 820 pg/ml, range <60 to 2340 pg/ml). In contrast, only 10.2% (4/39) of women with a negative amniotic fluid culture had detectable tumor necrosis factor. Histopathologic chorioamnionitis was found in all patients who had a positive amniotic fluid culture, and tumor necrosis factor was detectable in the amniotic fluid of all but one of these patients. Among women in active labor at term, 25% (21/84) had detectable tumor necrosis factor in the amniotic fluid. Tumor necrosis factor was detected more frequently in the amniotic fluid of patients with a positive amniotic fluid culture than in patients with a negative culture (46.6% [7/15] vs 20.2% [14/69], p = 0.047). Amniotic fluid concentrations of tumor necrosis factor were significantly higher in patients with preterm premature rupture of membranes, labor, and a positive amniotic fluid culture than in the other subgroups of patients with preterm premature rupture of membranes.
      Conclusion: Parturition in the setting of microbial invasion of the amniotic cavity is associated with activation of the cytokine network as demonstrated by the detection of tumor necrosis factor in human amniotic fluid.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Romero R
        • Mazor M
        • Wu YK
        • et al.
        Infection in the pathogenesis of preterm labor.
        Semin Perinatol. 1988; 12: 262-279
        • Romero R
        • Brody DT
        • Oyarzun E
        • et al.
        Infection and labor. III. Interleukin-1 : a signal for the onset of parturition.
        Am J Obstet Gynecol. 1989; 160: 1117-1123
        • Romero R
        • Durum S
        • Dinarello CA
        • Oyarzun E
        • Hobbins JC
        • Mitchell MD
        Interleukin-1 stimulates prostaglandin biosynthesis by human amnion.
        Prostaglandins. 1989; 37: 13-22
        • Romero R
        • Manogue KR
        • Mitchell MD
        • et al.
        Infection and labor. IV. Cachectin—tumor necrosis factor in the amniotic fluid of women with intraamniotic infection and preterm labor.
        Am J Obstet Gynecol. 1989; 161: 336-341
        • Romero R
        • Mazor M
        • Wu YK
        • Avila C
        • Oyarzun E
        • Mitchell MD
        Bacterial endotoxin and tumor necrosis factor stimulate prostaglandin production by human decidua.
        Prostaglandins Leukot Essent Fatty Acids. 1989; 37: 183-186
        • Casey ML
        • Cox SM
        • Beutler B
        • Milewich L
        • MacDonald PC
        Cachectin/tumor necrosis factor-a formation in human decidua.
        J Clin Invest. 1989; 83: 430-436
        • Romero R
        • Mazor M
        • Manogue K
        • Oyarzun E
        • Cerami A
        Human decidua: a source of cachectin-tumor necrosis factor.
        Eur J Obstet Gynecol Reprod Biol. 1991; 41: 123-127
        • Schutte MF
        • Treffers PE
        • Kloosterman GJ
        • Soepatmi S
        Management of premature rupture of membranes: the risk of vaginal examination to the infant.
        Am J Obstet Gynecol. 1983; 146: 395-400
        • Caritis SN
        A pharmacologic approach to the infusion of ritodrine.
        Am J Obstet Gynecol. 1988; 158: 380-384
        • Romero R
        • Scharf K
        • Mazor M
        • Emamian M
        • Hobbins JC
        • Ryan JL
        The clinical value of gas-liquid chromatography in the detection of intra-amniotic microbial invasion.
        Obstet Gynecol. 1988; 72: 44-50
        • Aggarwal BB
        • Kohr WJ
        • Hass PE
        • et al.
        Human tumor necrosis factor: production, purification, and characterization.
        J Biol Chem. 1985; 260: 2345-2354
        • Romero R
        • Avila C
        • Santhanam U
        • Sehgal PB
        Amniotic fluid interleukin 6 in preterm labor. Association with infection.
        J Clin Invest. 1990; 85: 1392-1400
        • Romero R
        • Oyarzun E
        • Stanley ER
        Macrophage-colony stimulating factor in amniotic fluid [Abstract 439].
        in: Proceedings of the thirty-sixth annual meeting of the Society for Gynecologic Investigation, San Diego, California, March 15–18, 1989 Society for Gynecologic Investigation, San Diego1989
      1. Romero R, Mazor M, Brandt F, Sepulveda W, Avila C, Dinarello CA. Interleukin-1α and interleukin-1ß in human preterm and term parturition. Am J Reprod Immunol [In press].

        • Romero R
        • Parvizi ST
        • Oyarzun E
        • et al.
        Amniotic fluid interleukin-1 in spontaneous labor at term.
        J Reprod Med. 1990; 35: 235-238
        • Prevedourakis CN
        • Strigou-Charalabis E
        • Kaskarelis DB
        Bacterial invasion of amniotic cavity during pregnancy and labor.
        Obstet Gynecol. 1971; 37: 459-461
        • Santhanam U
        • Avila C
        • Romero R
        • et al.
        Cytokines in normal and abnormal parturition: elevated amniotic fluid interleukin-6 levels in women with premature rupture of membranes associated with intrauterine infection.
        Cytokine. 1991; 3: 155-163
      2. Regulation of the acute phase and immune responses: interleukin-6.
        Ann N Y Acad Sci. 1989; 557 (Sehgal PB, Grieninger G, Tosato G, eds): 1-583