Clinical and immunological criteria of intrauterine infection
Objective. To identify clinical and immunological criteria for intrauterine infection (IUI) in pregnant women.Dolgushina V.F., Dolgushin I.I., Kurnosenko I.V., Lebedeva Yu.V.
Subjects and methods. A prospective cohort study was made in 327 pregnant women at 12-16 weeks, by using a continuous sampling method. Clinical, laboratory, instrumental, microbiological, and immunological studies were conducted, followed by a comparative analysis with placental morphological findings.
Results. A five-point scale of clinical criteria for IUI was developed, which included the following predictors: a compromised obstetric/gynecological history, the presence of cervicitis, recurrent threatened miscarriage, a number of echographic signs (abnormal amounts of amniotic fluid, placental structural changes), and impaired uteroplacental blood flow. In the presence of 4-5 points, the morphological features of IUI were found in 88.9-100% of the pregnant women. The most important immunological indicators are the levels of IL-1β, IL-10, and IL-17 in peripheral blood and those of sVE-cadherin and α-defensins in cervical mucus.
Conclusion. The use of these criteria for IUI during pregnancy can serve as the basis for predicting obstetric and perinatal complications and for performing etiopathogenetic treatments.
Keywords
cervicitis
intrauterine infection
innate immunity factors
Supplementary Materials
- FIG 1. Relative risk of intraunerine infection
- Table 1. Logistic regression for intraunerine infection
- Table 1. Risk of intraunerine infection depending on prognostic scale score
- Table 3. The diagnostic value of immunological parameters
- FIG 2. ROC-curves for IL in peripheral blood and cervical mucus
References
1. Ovsyannikova N.I., Kryukovskiy S.B., Smirnova T.I. Perinatal outcomes in pregnant women with a high risk of intrauterine infection. Vestnik novyih meditsinskih tehnologiy. 2010; 17(4): 39-41. (in Russian)
2. Posiseeva L.V., Panova I.A., Sotnikova N.Yu., Kudryashova A.V., Lukina N.S. Early predictors of the nature of pregnancy in women with urogenital infection markers. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2009; 2: 23-7. (in Russian)
3. Sidelnikova V.M. Infection is a risk factor for miscarriage. Ginekologiya. 2008; 10(5): 28-30. (in Russian)
4. Tirskaya Yu.I., Belkova T.N., Dolgih T.I., Rudakova E.B., Shakina I.A., Minakova E.Yu., Shelev M.V., Serbaev D.A. Prediction of intrauterine infection in pregnant women at high risk. Sibirskiy meditsinskiy zhurnal. 2011; 102(3): 65-9. (in Russian)
5. Tyutyunnik V.L., Kan N.E., Karapetyan T.E., Lomova N.A., Kogan E.A. The role of the opportunistic infections and vaginal factors of innate immunity in pregnant women to intrauterine infection. Problemyi reproduktsii. 2013; 19(4): 95-8. (in Russian)
6. Budanov P.V., Strizhakov A.N., Malinovskaya V.V., Kazarova Yu.V. Discoordination systemic inflammation in intrauterine infection. Voprosyi ginekologii, akusherstva i perinatologii. 2009; 8(2): 61-8. (in Russian)
7. Dolgushina V.F., Telesheva L.F., Dolgushin I.I. Local immunity of the reproductive system in women with genital infection. Zhurnal mikrobiologii, epidemiologii i immunobiologii. 2000; 2: 92-5. (in Russian)
8. Gankovskaya O.A., Kovalchuk L.V., Gankovskaya L.V., Lavrov V.F., Romanovskaya V.V., Kartashov D.D., Fenzeleva V.A. Role of Toll-like receptors and defensins in the antimicrobial protection of the urogenital tract of women. Zhurnal mikrobiologii, epidemiologii i immunobiologii. 2008; 1: 46-50. (in Russian)
9. Levkovich M.A. Modern views on the role of cytokines in the genesis of physiological and pathological course of pregnancy. Rossiyskiy vestnik akushera-ginekologa. 2008; 8(3): 37-40. (in Russian)
10. Makarov O.V., Kovalchuk L.V., Gankovskaya L.V. Miscarriage, infection, innate immunity. Moscow: GEOTAR-Media; 2007. 175p. (in Russian)
11. Sukhikh G.T., Vanko L.V. Immune factors in the etiology and pathogenesis of pregnancy complications. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; 1: 128-36. (in Russian)
12. Holst R.M., Laurini R., Jacobsson B., Samuelsson E., Sävman K., Doverhag C. et al. Expression of cytokines and chemokines in cervical and amniotic fluid: Relationship to histological chorioamnionitis. J. Matern. Fetal Neonatal Med. 2007; 20(12): 885-93.
13. Kim S.A., Park K.H., Lee S.M. Non-invasive prediction of histologic chorioamnionitis in women with preterm premature rupture of membranes. Yonsei Med. J. 2016; 57(2): 461-8.
14. Bersani I., Thomas W., Speer C.P. Chorioamnionitis – the good or the evil for neonatal outcome? J. Matern. Fetal Neonatal Med. 2012; 25(Suppl. 1): 12-6.
15. Conti N., Torricelli M., Voltolini C., Vannuccini S., Clifton V.L., Bloise E., Petraglia F. Term histologic chorioamnionitis: a heterogeneous condition. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015;188(1): 34-8.
16. Du H., Han X., Zhang L., Zhang H., Zhang Y. Pathological change of histologic chorioamnionitis and its association with neonatal inflammation. Zhonghua Bing Li Xue Za Zhi. 2015; 44(12): 864-7.
17. Higgins R.D., Saade G., Polin R.A., Grobman W.A., Buhimschi I.A., Watterberg K. et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis. Obstet. Gynecol. 2016; 127(3):426-36.
18. Kim M.A., Lee B.S., Park Y.W., Seo K. Serum markers for prediction of spontaneous preterm delivery in preterm labour. Eur. J. Clin. Invest. 2011; 41(7): 773-80.
19. Le S.Y.R., Leung C.W. Histological chorioamnionitis for bacterial colonization, laboratory markers of infection, and early onset sepsis in very-low-birth-weight neonates. J. Matern. Fetal Neonatal Med. 2012; 25(4): 364-8.
20. Romero R., Gotsch F., Pineles B., Kusanovic J.P. Inflammation in pregnancy: its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutr. Rev. 2007; 65(12, Pt 2): S194-202.
21. Grigorev S.G., Yunkerov V.I., Klimenko N.B Logistic regression. Multivariate statistical analysis of categorized data of medical research. St. Petersburg: VMedA; 2001. (in Russian)
22. Hanley J.A., McNeil B.J. A method of comparing area under ROC curves derived from the same cases. Radiology. 1983; 148(3): 839-43.
Received 15.06.2016
Accepted 02.09.2016
About the Authors
Dolgushina Valentina Fedorovna, MD, professor, head of the Department of Obstetrics and Gynecology, South Ural State Medical University, Ministry of Health of Russia. 454091, Russia, Chelyabinsk, Vorovsky str. 64. Tel.: +73517214632, +79193293245. E-mail: dolgushinavf@yandex.ruDolgushin Ilia Ilich, MD, Head of the department of Microbiology, Virology, Immunology and Clinical Laboratory Diagnostics, South Ural State Medical University,
Ministry of Health of Russia. 454091, Russia, Chelyabinsk, Vorovsky str. 64. Tel.: +73512327456, +79128912695. E-mail: Dol-ii@mail.ru
Kurnosenko Ilona Vladimirovna, PhD, associate professor the Department of Obstetrics and Gynecology, South Ural State Medical University, Ministry of Health of Russia. 454091, Russia, Chelyabinsk, Vorovsky str. 64. Tel.: +73517214632. E-mail: kurnosenko_ilona@mail.ru
Lebedeva Yuliana Valerievna, PhD, associate professor of the Department of Faculty Surgery, South Ural State Medical University, Ministry of Health of Russia.
454091, Russia, Chelyabinsk, Vorovsky str. 64. Tel.: +73512687319, +79222318911. E-mail: lebedevareg@mail.ru
For citations: Dolgushina V.F., Dolgushin I.I., Kurnosenko I.V., Lebedeva Yu.V. Clinical and immunological criteria of intrauterine infection.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (1): 40-5. (in Russian)
http://dx.doi.org/10.18565/aig.2017.1.40-5
Similar Articles
