Maternal plasma procalcitonin concentrations in patients with preterm labor and intact membranes--prediction of preterm delivery and admission-to-delivery interval

Establishment of reference intervals for maternal blood and umbilical cord blood procalcitonin in healthy Chinese women in late pregnancy

AIM

To establish reference intervals (RIs) for maternal blood and umbilical cord blood procalcitonin (PCT) in healthy Chinese women in late pregnancy.

METHODS

One hundred and twenty-seven healthy Chinese women in late pregnancy, including 70 vaginal deliveries and 57 cesarean section deliveries, were retrospectively analyzed. These pregnant women gave birth to 58 male infants and 69 female infants. Another 127 age-matched healthy women who were not pregnant were enrolled as the control group. PCT levels in maternal blood, umbilical cord blood and control blood were determined using electrochemiluminescence immunoassay. The RIs of PCT were defined using an intermediate 95% interval.

RESULTS

The RIs for maternal blood and umbilical cord blood PCT were 0.020-0.075 ng/mL and 0.020-0.159 ng/mL, respectively. The cord blood PCT level was not significantly different between different delivery methods (P > 0.05). In contrast, the umbilical cord blood PCT in female newborns was higher than that in male newborns (0.088 ± 0.046 ng/mL vs 0.072 ± 0.030 ng/mL, P < 0.05).

CONCLUSION

Maternal blood and umbilical cord blood PCT of Chinese women in late pregnancy have different RIs, and umbilical cord blood PCT level is affected by the gender of newborns.

Efficacy of serum procalcitonin to predict spontaneous preterm birth in women with threatened preterm labour: a prospective observational study

Background

A hypothesis of preterm parturition is that the pathogenesis of spontaneous preterm birth (sPTB) may be associated with an inflammatory process. Based on this theory, we have hypothesized that an inflammatory biomarker, procalcitonin (PCT), may be a good predictive marker of sPTB at the admission for threatened preterm labour (TPL). The present study was aimed to investigate the association between serum PCT and sPTB in women with TPL and to evaluate whether PCT levels may predict sPTB in women with TPL within 7 or 14 days.

Methods

In a prospective observational laboratory-based study, women with singleton pregnancies, TPL between 24 and 36 weeks and intact membranes, were enrolled between January 2014 and June 2016. Participants received routine medical management of TPL (tocolysis with atosiban, antenatal corticosteroids, and biological tests at admission (C-reactive protein, white blood cell count, and PCT measured on electrochemiluminescence immunoassay)). The primary endpoint was sPTB before 37 weeks of gestation. The value of serum PCT levels to predict sPTB within 7 or 14 days were evaluated using receiver-operating curves (ROC) analysis.

Results

A total of 124 women were included in our study. PCT levels did not statistically differ between women with sPTB (n = 30, 24.2%) and controls (n = 94) (median in ng/mL [interquartile range]: 0.043 [0.02–0.07] compared to 0.042 [0.02–0.13], respectively; P = 0.56). PCT levels did not also statistically differ between women with sPTB within 7 days (n = 7, 5.6%) or 14 days (n = 12, 9.7%) after testing and controls. Moreover, subgroup analysis revealed no difference among PCT levels at admission between 24 and 28 weeks, between 28 and 32 weeks and over 32 weeks, and controls. On the basis of the receiver-operating characteristic curve, the highest sensitivity and specificity corresponded to a PCT concentration of 0.038 ng/mL, with poor predictive values for sPTB within 7 or 14 days.

Conclusion

Serum PCT was not relevant to predict sPTB within 7 or 14 days in women admitted with TPL between 24 and 36 weeks, and thus it is not a suitable biological marker to confirm the hypothesis of an inflammatory process associated with preterm parturition.

Trial registration

Clinicaltrials.gov (NCT01977079), Registered 24 October 2013.

Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes

AIM

To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra-amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women.

METHODS

The mean plasma ProCT levels of 32 patients with PPROM, 35 patients with PROM at term, 24 healthy women at preterm gestation and 30 healthy women at term were compared. In the PPROM group, the presence or absence of histological chorioamnionitis and neonatal infection were used as a reference to analyze ProCT levels.

RESULTS

The mean ProCT level of patients in the PPROM group was significantly higher than those in the PROM group and healthy controls. Patients in the PPROM group diagnosed with histological chorioamnionitis had significantly higher ProCT levels than those of the remaining patients. At a cut-off of 0.054 ng/mL, the sensitivity and specificity of ProCT to predict histological chorioamnionitis were 92.3% and 68.4%, respectively.

CONCLUSION

ProCT levels were significantly higher in patients with PPROM, and facilitate identification of those who require expectant management.

Procalcitonin levels during pregnancy, delivery and postpartum

AIMS

To determine the normal value ranges of procalcitonin (PCT) in women with uncomplicated pregnancies.

METHODS

This prospective cohort study was conducted between May 2009 and February 2010 among 60 women without signs of clinical infection (31 vaginal deliveries, 29 cesarean sections) attending the maternity unit of the University of Geneva Hospitals. Sequential follow-up of PCT levels was performed at 24-28 weeks (n=7), 36-40 weeks (n=60), at delivery (n=59), and at days 2-3 (n=58) and 10 (n=53) postpartum using a sensitive PCT assay with a functional sensitivity of 0.06 μg/L.

RESULTS

Median levels of PCT were: 24-28 weeks: 0.043 μg/L (range 0.010-0.080); 36-40 weeks: 0.061 μg/L (range 0.010-0.110); at delivery: 0.068 μg/L (range 0.010-0.170); days 2-3: 0.200 μg/L (range 0.030-5.00); and day 10: 0.060 μg/L (range 0.020-0.120). At days 2-3 postpartum, three women had a PCT level between 0.25 μg/L and 0.5 μg/L and two women had a level higher than 0.5 μg/L.

CONCLUSIONS

This study provides reference values for PCT during the third trimester, at delivery and at the immediate postpartum period. A cut-off PCT level of 0.25 μg/L can be used during the third trimester, at delivery, and at the immediate postpartum period to rule out infection.

Maternal plasma procalcitonin concentrations in pregnancy complicated by preterm premature rupture of membranes

OBJECTIVES

Our objective is to compare maternal plasma procalcitonin concentrations in preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term with their levels in uncomplicated pregnancy, and to determine whether these concentrations are useful in the diagnosis of pPROM cases suspected of infection and in the prediction of pPROM-to-delivery interval.

STUDY DESIGN

Forty eight patients with pPROM, 30 with PROM at term, 31 healthy women at preterm gestation, and 33 healthy women at term were included. In pPROM group, analysis of procalcitonin concentrations with reference to leucocytosis, serum C-reactive protein, vaginal fluid culture, neonatal infection, histological chorioamnionitis and pPROM-to-delivery interval was carried out.

RESULTS

Procalcitonin concentrations in pPROM and PROM at term cases were comparable. However, in both groups procalcitonin values were significantly higher than in healthy controls in approximate gestational age. In pPROM group, procalcitonin concentrations between the patients with and without laboratory indices of infection were comparable, as well as between patients who gave birth to newborns with and without congenital infection, and between patients with and without histological chorioamnionitis. The predictive values of procalcitonin determinations were poor.

CONCLUSION

The value of maternal plasma procalcitonin determinations in the diagnostics of pPROM cases suspected of intraamniotic infection, as well as for the prediction of pPROM-to-delivery interval, newborn's infection or histological chorioamnionitis is unsatisfactory. However, procalcitonin concentrations are elevated, both in patients with preterm and term PROMs in comparison to healthy pregnants, and therefore further evaluations are necessary to establish the role of procalcitonin in the pathophysiology of pregnancy.

Maternal venous procalcitonin levels do not correlate with umbilical cord blood and venous blood concentrations in the neonate

BACKGROUND

To compare procalcitonin (PCT) concentrations between maternal blood and levels in umbilical cord or venous blood of neonates who were born with or without infection.

METHODS

Forty-six women with singleton pregnancies, complicated by premature rupture of membranes, preterm delivery and/or chorioamnionitis, were enrolled in this study. The study group comprised 15 patients and their infected newborns. The control group consisted of 31 women and their healthy newborns. We compared PCT concentrations between maternal, umbilical cord and neonatal serum, in both study and control groups. Additionally, PCT levels were compared between the corresponding compartments.

RESULTS

PCT concentrations in the umbilical cord and venous blood in infected newborns, but not in non-infected neonates, were significantly higher than maternal serum PCT levels. PCT concentrations of mothers who delivered infected newborns were comparable to those in the controls. However, PCT concentrations in the umbilical cord and in the venous blood of the infected newborns were higher than in healthy newborns.

CONCLUSION

Measurement of maternal PCT concentration during labor does not contribute to early prediction of infection in the neonate. However, umbilical cord PCT concentrations, as well as its neonatal venous levels on the second day of life, seem to be related to intrauterine infection, and may be a useful tool in the diagnosis of early neonatal infection.

Are vaginal fluid procalcitonin levels useful for the prediction of subclinial infection in patients with preterm premature rupture of membranes?

AIM

To compare vaginal fluid procalcitonin concentrations in cases of preterm premature rupture of membranes (pPROM) and premature rupture of membranes (PROM) at term, and to determine whether the procalcitonin concentrations are of value in the diagnosis of pPROM cases suspected of subclinical intrauterine infection or in the prediction of the pPROM-to-delivery interval.

METHODS

Forty-eight patients with pPROM and 30 with PROM at term were enrolled in this study. In pPROM group, analysis was conducted of procalcitonin concentrations with reference to serum leucocytosis, serum C-reactive protein levels and vaginal fluid culture, as well as to the presence/absence of neonatal congenital infection or histological chorioamnionitis. The outcomes of pPROM cases were also recorded with reference to pPROM-to-delivery interval.

RESULTS

Procalcitonin levels in the pPROM group were significantly higher than in cases of amniorrhexis at term (1.50 vs 0.83 ng/mL; P < 0.001). In the pPROM group procalcitonin concentrations between the patients with and without positive laboratory indices of infection were comparable. Also, no significant correlation was observed between procalcitonin and leucocytosis (r = -0.14; P = 0.33) or C-reactive protein (r = -0.17; P = 0.24). Procalcitonin concentrations of patients who gave birth to newborns with infection were comparable to those in women whose newborns were healthy. In patients with histological chorioamnionitis, procalcitonin concentrations were comparable to those without inflammatory changes.

CONCLUSION

These findings suggest that the value of vaginal fluid procalcitonin determinations is unsatisfactory in the diagnostics of pPROM cases suspected of subclinical intrauterine infection, as well as for the prediction of pPROM-to-delivery interval, newborn's congenital infection or histological chorioamnionitis.