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Amniotic fluid interleukin-6: Correlation with upper genital tract microbial colonization and gestational age in women delivered after spontaneous labor versus indicated delivery

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      Abstract

      OBJECTIVE: Our purpose was to determine whether amniotic fluid interleukin-6 is increased and inversely proportional to gestational age in women with chorioamnion colonization and spontaneous labor versus women delivered for medical or obstetric indications.
      STUDY DESIGN: The chorioamnion and amniotic fluid were cultured at cesarean delivery for aerobic and anaerobic bacteria, fungi, mycoplasmas, Chlamydia trachomatis and Trichomonas vaginalis in 269 women with singleton gestations with intact membranes. The amniotic fluid interleukin-6 concentration was also determined.
      RESULTS: Amniotic fluid interleukin-6 levels were (1) higher in women with spontaneous labor versus those with indicated deliveries (15.8 ± 5.0 vs 2.2 ± 0.2 ng/ml, p = 0.01), (2) inversely proportional to gestational age in women with spontaneous labor (<34 weeks: 47.4 ± 18.0 ng/ml vs ≥34 weeks: 8.7 = 4.1 ng/ml, p = 0.001) but not in women with indicated deliveries (1.5 ± 0.4 vs 2.4 ± 0.3 ng/ml), (3) higher in women with a positive versus a negative chorioamnion (15.1 = 4.8 vs 3.0 ± 0.8 ng/ml, p < 0.001) or amniotic fluid (17.4 ± 7.7 vs 3.8 ± 0.9 mg/ml, p < 0.001) culture, and (4) higher in women with a negative amniotic fluid but positive chorioamnion culture compared with women in whom both cultures were negative (10.0 = 4.4 vs 3.0 ± 0.9 ng/ml, p = 0.002).
      CONCLUSIONS: Amniotic fluid interleukin-6 levels are (1) higher and inversely proportional to gestational age in women with intact membranes and spontaneous labor versus indicated deliveries, (2) higher in women with one or more microorganisms in the chorioamnion or amniotic fluid, and (3) reflective of chorioamnion microbial colonization, even when the amniotic fluid culture is negative, and may be a useful clinical marker for infection-mediated preterm labor.

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      References

        • Mitchell MD
        • Dudley DJ
        • Edwin SS
        • Schiller SL
        Interleukin-6 stimulate prostaglandin production by human amnion and decidua cells.
        Eur J Pharmacol. 1991; 192: 189-191
        • 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
        • Coultrip L
        • Lien JM
        • Koury A
        • Grossman JH
        The value of amniotic fluid interleukin-6 determination in patients with preterm labor and intact membranes in the detection of microbial invasion of the amniotic cavity.
        Am J Obstet Gynecol. 1994; 170 ([Abstract]): 278
        • Hillier SL
        • Witkin SS
        • Krohn MA
        • Watts DH
        • Kiviat NB
        • Eschenbach DA
        The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection.
        Obstet Gynecol. 1993; 81: 941-948
        • Romero R
        • Yoon BH
        • Mazur M
        • et al.
        The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and Gram stain in patients with preterm labor and intact membranes.
        Am J Obstet Gynecol. 1993; 169: 805-816
        • Romero R
        • Yoon BH
        • Mazur M
        • et al.
        A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and Gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes.
        Am J Obstet Gynecol. 1993; 169: 839-851
        • Yoon BH
        • Romero R
        • Chun CK
        • et al.
        The prognostic value of interleukin-6 determinations in patients with preterm labor.
        Am J Obstet Gynecol. 1994; 170 ([Abstract]): 278
        • Cassell GH
        • Waites KB
        • Taylor-Robinson D
        Genital mycoplasmas.
        in: 5th ed. Atlas of sexually transmitted diseases. 7. Lippincott/Gower, Philadelphia1990: 2-15
        • Cassell GH
        • Blanchard A
        • Duffy L
        • Crabb D
        • Waites KB
        Mycoplasmas.
        in: Howard BJ Clinical and pathogenic microbiology. Mosby-Year Book, St. Louis1993: 491-502
        • Taylor-Robinson D
        • Chen TA
        Growth inhibitory factors in animal and plant tissues.
        in: Razin S Tully JG Methods in mycoplasmology. Academic Press, New York1983: 109-114
        • Cassell GH
        • Watson HL
        • Blalock DK
        • Horowitz SA
        • Duffy LB
        Protein antigens of genital mycoplasmas.
        Rev Inf Dis. 1988; 10: S391-S398
        • Blanchard A
        • Dybvig YK
        • Watson HL
        • Griffiths G
        • Cassell GH
        Evaluation of intraspecies genetic variation within the 16S rRNA gene of Mycoplasma hominis and detection by polymerase chain reaction.
        J Clin Microbiol. 1993; 31: 1358-1361
      1. 5th ed. Manual of clinical microbiology. American Society for Microbiology, Washington, DC1991
        • Sutter VL
        • Citron DM
        • Edelstein MAC
        • Finegold SM
        4th ed. Wadsworth anaerobic bacteriology manual. Star Publishing, Belmont, California1985
      2. 4th ed. Anaerobic laboratory manual. Virginia Polytechnic Institute and State University, Blacksberge, Virginia1977
        • Cassell GH
        • Andrews WW
        • Hauth JC
        • et al.
        Isolation of microorganism from the chorioamnion is twice that from amniotic fluid at cesarean delivery in women with intact membranes.
        Am J Obstet Gynecol. 1993; 168 ([Abstract]): 424
        • Cassell G
        • Hauth JC
        • Andrews W
        • Cutter G
        • Goldenberg R
        Chorioamnion colonization: correlation with gestational age in women delivered following spontaneous labor versus indicated delivery.
        Am J Obstet Gynecol. 1993; 168 ([Abstract]): 425
        • Hillier SL
        • Krohn MA
        • Kivial NB
        • Watts DH
        • Eschenbach DA
        Microbiologic causes and neonatal outcomes associated with chorioamnion infection.
        Am J Obstet Gynecol. 1991; 165: 955-961
        • Watts DH
        • Krohn MA
        • Hillier SL
        • Eschenbach DA
        The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labor.
        Obstet Gynecol. 1992; 79: 351-357