Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: “Carroll-Model” Revisited
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Population
2.2. Clinical Characteristics and Pregnancy Outcomes
2.3. Amniotic Fluid (AF)
2.4. Diagnosis of Acute Histologic Chorioamnionitis (Acute-HCA) and Funisitis
2.5. Statistical Analysis
3. Results
3.1. Clinical Characteristics and Pregnancy Outcomes According to Gestational Age at Amniocentesis in Either Preterm Labor and Intact Membranes (PTL) or Preterm Premature Rupture of Membranes (Preterm-PROM) with the Same Intensity of Intra-Amniotic Inflammation (IAI)
3.2. Frequency of Intra-Amniotic Inflammation (IAI) and Severe IAI as a Function of Gestational Age (GA) in Cases with PTL and Preterm-PROM
3.3. Frequency of Intra-Amniotic Inflammation (IAI) and Severe IAI as a Function of Gestational Age (GA) in Cases with PTL and Preterm-PROM
3.4. Relationships between Gestational Age (GA) at Amniocentesis and Amniocentesis-to-Delivery (ATD) Interval in PTL and Preterm-PROM
3.5. Relationships between Gestational Age (GA) at Amniocentesis and Amniocentesis-to-Delivery (ATD) Interval in the Context of the Same Intensity of Intra-Amniotic Inflammation (IAI) in PTL and Preterm-PROM
4. Discussion
4.1. The Principal Finding of the Study
4.2. Limitations of Previous Studies (Figure 6)
4.3. Why Are PTL and Preterm-PROM at a Lower Gestational Age (GA) Associated with a Longer Latency to Delivery?
4.4. Prostaglandins (PGs) Change in Amniotic Fluid (AF) and Amnion According to the Development of Inflammation and Advancing Gestational Age (GA) Ultimately Leading to Labor and Delivery
4.5. Biologic Plausibility about the Current Study’s Findings That PTL and Preterm-PROM at a Lower Gestational Age (GA) Are Associated with a Longer Latency to Delivery Even in the Context of the Same Intensity of IAI
4.6. Major Strengths and Weakness of Current Study
4.7. Clinical Implications of Current Study
4.8. Unanswered Questions and Proposals for Further Studies
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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GA at Amniocentesis | <26 Wks Group-1 | 26 Wks~30 Wks Group-2 | 30 Wks~34 Wks Group-3 | p † |
---|---|---|---|---|
(n = 42) | (n = 76) | (n = 135) | ||
IAI (-) [n = 158] | (n = 17) | (n = 40) | (n = 101) | |
Maternal age, years (mean ± SD) | 31.53 ± 4.32 | 32.03 ± 5.05 | 30.37 ± 4.13 | NS (0.169) |
Nulliparity | 64.7% (11/17) | 57.5% (23/40) | 53.5% (54/101) | NS (0.665) |
GA at delivery, wks (mean ± SD) | 33.42 ± 5.99 | 34.58 ± 4.50 | 35.51 ± 2.90 | NS (0.539) |
Birth weight, g (mean ± SD) | 2240 ± 987 | 2384 ± 859 | 2517 ± 677 | NS (0.642) |
Male newborn | 47.1% (8/17) | 55.0% (22/40) | 50.5% (51/101) | NS (0.832) |
Cesarean section | 29.4% (5/17) | 55.0% (22/40) | 45.5% (46/101) | NS (0.440) |
Acute-HCA * or funisitis | 35.3% (6/17) | 27.5% (11/40) | 21.8% (22/101) | NS (0.439) |
Mild IAI [n = 51] | (n = 9) | (n = 21) | (n = 21) | |
Maternal age, years (mean ± SD) | 29.56 ± 3.09 | 29.48 ± 4.51 | 30.71 ± 4.17 | NS (0.578) |
Nulliparity | 66.7% (6/9) | 47.6% (10/21) | 47.6% (10/21) | NS (0.584) |
GA at delivery, wks (mean ± SD) | 27.29 ± 5.04 | 30.43 ± 3.95 | 32.50 ± 1.39 | <0.001 |
Birth weight, g (mean ± SD) | 1199 ± 829 | 1655 ± 810 | 1966 ± 389 | 0.006 |
Male newborn | 66.7% (6/9) | 57.1% (12/21) | 38.1% (8/21) | NS (0.272) |
Cesarean section | 33.3% (3/9) | 47.6% (10/21) | 38.1% (8/21) | NS (0.715) |
Acute-HCA * or funisitis | 66.7% (6/9) | 71.4% (15/21) | 61.9% (13/21) | NS (0.807) |
Severe IAI [n = 44] | (n = 16) | (n = 15) | (n = 13) | |
Maternal age, years (mean ± SD) | 31.69 ± 4.60 | 29.80 ± 3.80 | 30.54 ± 5.13 | NS (0.707) |
Nulliparity | 37.5% (6/16) | 40.0% (6/15) | 38.5% (5/13) | NS (0.990) |
GA at delivery, wks (mean ± SD) | 25.01 ± 0.91 | 28.92 ± 2.89 | 32.20 ± 1.28 | <0.001 |
Birth weight, g (mean ± SD) | 759 ± 167 | 1286 ± 468 | 1771 ± 553 | <0.001 |
Male newborn | 43.8% (7/16) | 53.3% (8/15) | 69.2% (9/13) | NS (0.388) |
Cesarean section | 37.5% (6/16) | 20.0% (3/15) | 38.5% (5/13) | NS (0.480) |
Acute-HCA * or funisitis | 87.5% (14/16) | 93.3% (14/15) | 84.6% (11/13) | NS (0.757) |
GA at Amniocentesis | <26 Wks Group-1 | 26 Wks~30 Wks Group-2 | 30 Wks~34 Wks Group-3 | p † |
---|---|---|---|---|
(n = 39) | (n = 56) | (n = 128) | ||
IAI (-) [n = 127] | (n = 12) | (n = 28) | (n = 87) | |
Maternal age, years (mean ± SD) | 29.83 ± 2.59 | 30.29 ± 5.26 | 30.84 ± 4.53 | NS (0.573) |
Nulliparity | 83.3% (10/12) | 57.1% (16/28) | 51.7% (45/87) | NS (0.117) |
GA at delivery, wks (mean ± SD) | 35.00 ± 6.25 | 33.37 ± 4.02 | 34.32 ± 2.00 | NS (0.071) |
Birth weight, g (mean ± SD) | 2581 ± 1344 | 2047 ± 767 | 2287 ± 485 | 0.027 |
Male newborn | 50.0% (6/12) | 60.7% (17/28) | 58.6% (51/87) | NS (0.814) |
Cesarean section | 50.0% (6/12) | 35.7% (10/28) | 34.5% (30/87) | NS (0.576) |
Acute-HCA * or funisitis | 41.7% (5/12) | 46.4% (13/28) | 44.8% (39/87) | NS (0.962) |
Mild IAI [n = 52] | (n = 12) | (n = 14) | (n = 26) | |
Maternal age, years (mean ± SD) | 33.25 ± 3.89 | 30.07 ± 4.20 | 29.92 ± 3.67 | NS (0.075) |
Nulliparity | 16.7% (2/12) | 21.4% (3/14) | 53.8% (14/26) | 0.034 |
GA at delivery, wks (mean ± SD) | 27.87 ± 4.58 | 30.16 ± 2.03 | 33.01 ± 1.10 | <0.001 |
Birth weight, g (mean ± SD) | 1234 ± 792 | 1500 ± 514 | 1957 ± 257 | <0.001 |
Male newborn | 66.7% (8/12) | 42.9% (6/14) | 53.8% (14/26) | NS (0.479) |
Cesarean section | 33.3% (4/12) | 42.9% (6/14) | 50.0% (13/26) | NS (0.625) |
Acute-HCA * or funisitis | 75.0% (9/12) | 92.9% (13/14) | 84.6% (22/26) | NS (0.453) |
Severe IAI [n = 44] | (n = 15) | (n = 14) | (n = 15) | |
Maternal age, years (mean ± SD) | 31.67 ± 4.62 | 31.86 ± 5.60 | 31.13 ± 3.40 | NS (0.987) |
Nulliparity | 46.7% (7/15) | 35.7% (5/14) | 40.0% (6/15) | NS (0.832) |
GA at delivery, wks (mean ± SD) | 25.47 ± 3.51 | 28.48 ± 1.27 | 32.27 ± 1.13 | <0.001 |
Birth weight, g (mean ± SD) | 914 ± 730 | 1208 ± 182 | 1892 ± 308 | <0.001 |
Male newborn | 73.3% (11/15) | 71.4% (10/14) | 53.3% (8/15) | NS (0.446) |
Cesarean section | 26.7% (4/15) | 57.1% (8/14) | 26.7% (4/15) | NS (0.147) |
Acute-HCA * or funisitis | 86.7% (13/15) | 78.6% (11/14) | 100% (15/15) | NS (0.184) |
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Sohn, J.-W.; Choi, E.-S.; Park, C.-W.; Moon, K.-C.; Park, J.-S.; Jun, J.-K. Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: “Carroll-Model” Revisited. Life 2022, 12, 1329. https://doi.org/10.3390/life12091329
Sohn J-W, Choi E-S, Park C-W, Moon K-C, Park J-S, Jun J-K. Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: “Carroll-Model” Revisited. Life. 2022; 12(9):1329. https://doi.org/10.3390/life12091329
Chicago/Turabian StyleSohn, Jeong-Won, Eun-Saem Choi, Chan-Wook Park, Kyung-Chul Moon, Joong-Shin Park, and Jong-Kwan Jun. 2022. "Preterm Labor and Preterm-PROM at a Lower Gestational Age Are Associated with a Longer Latency-to-Delivery Even in Patients with the Same Intensity of Intra-Amniotic Inflammation: “Carroll-Model” Revisited" Life 12, no. 9: 1329. https://doi.org/10.3390/life12091329