Measurement of Interleukin 8 in Cervicovaginal Fluid in Women With Preterm Premature Rupture of Membranes

Abstract

Cervicovaginal fluid (CVF) samples may be a feasible alternative to amniotic fluid (AF) sampling in women with preterm premature rupture of the membranes (PPROMs), because PPROM causes AF to spill into the CVF. We aimed to assess the correlation and limits of agreement of interleukin 8 (IL-8) levels between CVF and AF in women with PPROM and to compare the clinical value of CVF IL-8 to AF IL-8 for the prediction of microbial invasion of amniotic cavity (MIAC). A retrospective cohort observational study was conducted on 85 women with singleton pregnancies (24-34 weeks) presenting with PPROM. The CVF samples were obtained simultaneously with AF samples retrieved by transabdominal amniocentesis. The levels of IL-8 in paired CVF and AF samples were measured with enzyme-linked immunosorbent assay in the same plate in duplicate using the same dilutions. The prevalence of a positive AF culture was 40% (34 of 85). The CVF IL-8 levels were significantly and positively correlated with AF IL-8 levels (r = 0.778). However, the level of agreement between CVF and AF IL-8 levels yielded a Cohen κ statistic of 0.276. Paired Student t test revealed that the difference between CVF and AF IL-8 levels was statistically significant. The area under the curve for AF IL-8 was significantly higher than that for CVF IL-8 (P = .013). In women with PPROM, IL-8 levels in CVF were significantly correlated with, but were significantly different from, those in AF samples. The CVF IL-8 has moderate predictive capability for the risk of MIAC, but this is inferior to AF IL-8.

Keywords

amniotic fluid cervicovaginal fluid correlation limits of agreement preterm premature rupture of the membranes

Get full access to this article

View all access options for this article.

References

Caughey

Robinson

Norwitz

. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008;1(1):11–22.

Goncalves

Chaiworapongsa

Romero

. Intrauterine infection and prematurity. Ment Retard Dev Disabil Res Rev. 2002;8(1):3–13.

Park

Kim

Lee

Jeong

Ryu

. Noninvasive prediction of intra-amniotic infection and/or inflammation in preterm premature rupture of membranes. Reprod Sci. 2012;19(6):658–665.

Romero

Yoon

Mazor

. 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(4):839–851.

Yoon

Jun

Park

Syn

Gomez

Romero

. Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes. Obstet Gynecol. 1996;88(6):1034–1040.

Cobo

Jacobsson

Kacerovsky

. Systemic and local inflammatory response in women with preterm prelabor rupture of membranes. PLoS One. 2014;9(1): e85277.

Puchner

Egarter

Wimmer

Lederhilger

Weichselbraun

. Amniotic fluid interleukin-8 as a marker for intraamniotic infection. Arch Gynecol Obstet. 1993;253(1):9–14.

Ryu

Park

Lee

Jeong

Park

. Predictive value of combined cervicovaginal cytokines and gestational age at sampling for intra-amniotic infection in preterm premature rupture of membranes. Acta Obstet Gynecol Scand. 2013;92(5):517–524.

Jun

Yoon

Romero

. Interleukin 6 determinations in cervical fluid have diagnostic and prognostic value in preterm premature rupture of membranes. Am J Obstet Gynecol. 2000;183(4):868–873.

10.

Rizzo

Capponi

Vlachopoulou

Angelini

Grassi

Romanini

. Interleukin-6 concentrations in cervical secretions in the prediction of intrauterine infection in preterm premature rupture of the membranes. Gynecol Obstet Invest. 1998;46(2):91–95.

11.

Kacerovsky

Musilova

Jacobsson

. Vaginal fluid IL-6 and IL-8 levels in pregnancies complicated by preterm prelabor membrane ruptures. J Matern Fetal Neonatal Med. 2015;28(4):392–398.

12.

Buhimschi

Sfakianaki

Hamar

. A low vaginal “pool” amniotic fluid glucose measurement is a predictive but not a sensitive marker for infection in women with preterm premature rupture of membranes. Am J Obstet Gynecol. 2006;194(2):309–316.

13.

Lee

Park

Jeong

Ryu

Kim

. Intra-amniotic infection/inflammation as a risk factor for subsequent ruptured membranes after clinically indicated amniocentesis in preterm labor. J Korean Med Sci. 2013;28(8):1226–1232.

14.

Gibbs

Blanco

St Clair

Castaneda

. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis. 1982;145(1):1–8.

15.

Fleiss

Kingman

Statistical management of data in clinical research. Crit Rev Oral Biol Med. 1990;1(1):55–66.

16.

Landis

Koch

. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174.

17.

DeLong

Clarke-Pearson

. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–845.

18.

Jacobsson

Mattsby-Baltzer

Andersch

. Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand. 2003;82(5):423–431.

19.

Fichorova

Desai

Gibson

III Genco

. Distinct proinflammatory host responses to Neisseria gonorrhoeae infection in immortalized human cervical and vaginal epithelial cells. Infect Immun. 2001;69(9):5840–5848.

20.

Kacerovsky

Musilova

Jacobsson

. Cervical fluid IL-6 and IL-8 levels in pregnancies complicated by preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med. 2015;28(2):134–140.

21.

Park

Kim

Jeong

Lee

Yoon

. Predictive value of intra-amniotic and serum markers for inflammatory lesions of preterm placenta. Placenta. 2011;32(10):732–736.

22.

Hillier

Witkin

Krohn

Watts

Kiviat

Eschenbach

. The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection. Obstet Gynecol. 1993;81(6):941–948.

23.

Jung

Park

Lee

Ryu

Joo

Park

. Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid. Int J Gynaecol Obstet. 2016;132(2):165–169. pii: S0020-7292(15)00639-6.