Fetal, amniotic and maternal inflammatory responses in early stage of ascending intrauterine infection, inflammation restricted to chorio-decidua, in preterm gestation

Objective: No data exist on the frequency and intensity of the fetal, intraamniotic and maternal inflammation in preterm-gestations with inflammation restricted to chorio-decidua, early stage of ascending intrauterine infection. The objective of the study is to examine this issue. Study Design: The frequency and intensity of fetal (cord blood C-reactive protein [CRP] at birth > 200 ng/ml), intraamniotic (amniotic fluid matrix metalloproteinase-8 [MMP-8] > 23 ng/ml) and maternal (maternal serum CRP > 0.7 ng/ml) inflammation were compared in 304 singleton preterm-gestations (< 35.4 weeks) delivered within 5 days of amniocentesis. Placental pathology was divided into placenta without any inflammation, inflammation restricted to chorio-decidua and inflammation beyond chorio-decidua. Results: Intraamniotic inflammation, but not fetal or maternal inflammation, was significantly more frequent (43.2% versus 10.5%; p < 0.005) and intense (median amniotic fluid MMP-8; 7.5 ng/ml versus 1.3 ng/ml; p < 0.001) in inflammation restricted to chorio-decidua than in placenta without any inflammation. However, inflammation restriced to chorio-decidua was associated with a significantly lower rate and intensity of fetal, intraamniotic and maternal inflammation than inflammation beyond chorio-decidua (each for p < 0.05). Conclusion: Intraamniotic inflammation was more frequent and intense in patients with inflammation restricted to chorio-decidua than in those without placental inflammation. However, fetal and maternal inflammatory responses were similar between these two groups.