Advertisement

47: The antenatal identification of funisitis (fetal inflammation) with a rapid MMP-8 bedside test

      Objective

      Fetal inflammation is a powerful predictor of short and long-term adverse outcomes including cerebral palsy. Neutrophils in the amniotic cavity are of fetal origin and can produce matrix metalloproteinase-8 (MMP-8). Therefore, the detection of an elevated MMP-8 in amniotic fluid (AF) may indicate fetal systemic inflammation. The purpose of this study was to determine if bedside test, MMP-8 PTD Check™, can be of value in the antenatal identification of funisitis. This test requires no equipment and can be performed in 15 minutes.

      Study design

      The relationship between the presence of funisitis and the results of MMP-8 PTD Check™ test was examined in 139 patients who delivered preterm singleton neonates (gestational age <35 weeks) within 72 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas. AF was analyzed for white blood cell (WBC) count, interleukin-6 (IL-6) and the MMP-8 PTD Check™ test. IL-6 concentration was also determined in umbilical cord plasma collected at birth. Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton jelly. Nonparametric techniques were used for statistical analysis.

      Results

      1) Funisitis was present in 27% (38/139) of cases; 2) A positive MMP-8 PTD Check™ test had a sensitivity of 97% (37/38), a specificity of 63% (64/101), a positive predictive value of 50% (37/74) and a negative predictive value of 99% (64/65) in the identification of funisitis; 3) Among cases without funisitis, patients with a positive MMP-8 PTD Check™ test had significantly higher median AF IL-6 concentration, AF WBC count, and umbilical cord plasma IL-6 concentration at birth than those with a negative MMP-8 PTD Check™ test (p<0.05 for each).

      Conclusion

      The MMP-8 PTD Check™ test is a rapid, simple and sensitive bedside test which allows assessment of the risk of funisitis (fetal inflammation).