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Korean Journal of Obstetrics & Gynecology 1997;40(7):1379-1389.
Published online January 1, 2001.
The Diagnostic and Prognostic Value of Maternal Blood C-reactive Protein in Patients with Preterm Labor and Intact Membranes.
Soon Ha Yang, Bo Hyun Yoon, Jin Yong Lee
1Department of Obstetrics and Gynecology, College of Medicine, Sungkunkwan University, Samsung Medical Center, Seoul, Korea.
2Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea.
Abstract
BACKGROUND: Intrauterine infection has been recognized as a major etiologic factor for preterm labor and delivery. Moreover, an accumulating body of evidence suggests that intrauterine infection is associated with poor perinatal outcome. Several antenatal tests, including amniotic fluid tests, have been proposed to be useful in the identification of intrauterine infection and prediction of adverse perinatal outcome in patients with preterm labor and intact membranes. However, those tests require the performance of an invasive procedure, amniocentesis. Maternal blood C-reactive protein(CRP) has been studied extensively as a noninvasive test in the diagnosis of intrauterine infection. OBJECTIVE: 1) to determine the diagnostic performance of maternal bood CRP in identification of intrauterine infection and 2) to establish the prognostic value of maternal blood CRP as an antepartum test for neonatal morbidity, especially sepsis, in neonates born to mothers with preterm labor and intact membrances. STUDY DESIGN: Maternal blood samples for CRP tests were obtained at the time of admission in 91 patients with preterm labor and intact membranes. Serum CRP concentrations were measured by antibody adsorption-particle agglutination assay technique. Histologic examination of delivered placenta and follow-up for maternal and neonatal outcome were performed. Receiver-operator characteristic(ROC) curve, logistic regression, and survival analysis techniques were used for statistical analysis. RESULTS: Patients with acute histologic chorioamnionitis had significantly higher median maternal blood CRP concentration than did patients without this lesion. ROC curve and survival analysis demonstrated that an elevated CRP concentration was strongly associated with the likelihood of acute histologic chorioamnionitis, shorter admission-to-delivery interval, significant neonatal morbidity, and neonatal sepsis. Multiple logistic regression analysis indicated that maternal blood CRP was a significant independent predictor for the occurrence of neonatal morbidity and neonatal sepsis even after adjustment of other independent variables. CONCLUSION: The results of this study suggest that maternal blood CRP has a diagnostic and prognostic value in patients with preterm labor and intact membranes.
Key Words: C-reactive protein, Preterm labor, Acute histologic chorioamnionitis, Neonatal morbidity


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