Predictive value of maternal C-reactive protein for detection of histological chorioamnionitis in women with prelabor rupture of membranes

  • Dr. Animesh Naskar Assistant Professor, Department of Gynecology and Obstetrics, R.G. Kar Medical College & Hospital, 1 Khudiram Bose Sarani, Kolkata, West Bengal, India
  • Dr. Somnath Ghosh Ex-Medical Officer, Department of Pathology, R.G. Kar Medical College & Hospital, 1 Khudiram Bose Sarani, Kolkata, West Bengal, India
Keywords: Chorioamnionitis, C-reactive protein, Predictive value, Prelabor rupture of membrane


Introduction: Chorioamnionitis can be considered as an unwanted aftermath of PROM and is capable of causing considerable perinatal morbidity and mortality. It has been a focus of interest in many studies. The ability to predict histological chorioamnionitis is a high priority for Obstetricians managing women with PROM at or after 34 weeks. During the last three decades, CRP has been a useful marker of chorioamnionitis and its dreaded sequel.

Materials and Methods: With a specific objective to assess the predictive value of maternal CRP in patients with documented histological chorioamnionitis, 80 patients with high CRP value (>10mg/l) with PROM constituted the study group, against a matched control of 84 patients with low CRP value (<10 mg/l) in our study conducted in a tertiary care center in India. Labor process and management of patients were noted. Follow up was done for the mode of delivery, maternal and neonatal morbidity.

Results: Significant correlation was found between high CRP (>10mg/l) and histologically proven chorioamnionitis with a sensitivity of 93%, specificity 80%, positive predictive value 75%, and P < 0.0001. Also there is significant correlation between high CRP (>10mg/l) and maternal and neonatal morbidity.

Conclusion: CRP is a significant relevant predictor of histological chorioamnionitis, maternal and neonatal morbidity.


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1. Popowski T, Goffinet F, Maillard F, et al. Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study. BMC Pregnancy Childbirth. 2011 Apr 7;11:26. DOI: 10.1186/1471-2393-11-26.[pubmed]

2. Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res. 1997 Jul;42(1):1-8. DOI:10.1203/00006450-199707000-00001.[pubmed]

3. Dong Y, St Clair PJ, Ramzy I, et al. A microbiologic and clinical study of placental inflammation at term. Obstet Gynecol. 1987 Aug;70(2):175-82.[pubmed]

4. Thompson D, Pepys MB, Wood SP. The physiological structure of human C-reactive protein and its complex with phosphocholine. Structure. 1999 Feb 15;7(2):169-77.[pubmed]

5. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003 Jun 15;111(12):1805-12. DOI:10.1172/JCI18921.[pubmed]

6. Smulian JC, Shen-Schwarz S, Vintzileos AM, et al. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol. 1999 Dec;94(6):1000-5.[pubmed]

7. Pettker CM, Buhimschi IA, Magloire LK, et al. Value of placental microbial evaluation in diagnosing intra-amniotic infection. Obstet Gynecol. 2007 Mar;109(3):739-49. DOI:10.1097/01.AOG.0000255663.47512.23

8. Riggs JW, Blanco JD. Pathophysiology, diagnosis, and management of intraamniotic infection. Semin Perinatol. 1998 Aug;22(4):251-9.[pubmed]

9. Holcroft CJ, Askin FB, Patra A et al. Are histopathologic chorioamnionitis and funisitis associated with metabolic acidosis in the preterm fetus? Am J Obstet Gynecol. 2004 Dec;191(6):2010-5. DOI:10.1016/j.ajog.2004.05.005.

10. Garite TJ, Freeman RK. Chorioamnionitis in the preterm gestation. Obstet Gynecol. 1982 May;59(5):539-45.[pubmed]

11. Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010 Jun;37(2):339-54. DOI: 10.1016/j.clp.2010.02.003.[pubmed]

12. Seong HS, Lee SE, Kang JH, et al. The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor. Am J Obstet Gynecol. 2008 Oct;199(4):375.e1-5. DOI: 10.1016/j.ajog.2008.06.040.[pubmed]

13. McGregor JA, Schoonmaker JN, Lunt BD, et al. Antibiotic inhibition of bacterially induced fetal membrane weakening. Obstet Gynecol. 1990 Jul;76(1):124-8.[pubmed]

14. Buhimschi CS, Sfakianaki AK, Hamar BG et al. 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, Feb; 194(2): 309-16; DOI: 10.1016/j.ajog.2005.07.070.

15. Maeda K, Matsuzaki N, Fuke S, et al. Value of the maternal interleukin 6 level for determination of histologic chorioamnionitis in preterm delivery. Gynecol Obstet Invest. 1997;43(4):225-31. DOI: 10.1159/000291862.[pubmed]

16. Howman RA, Charles AK, Jacques A, et al. Inflammatory and haematological markers in the maternal, umbilical cord and infant circulation in histological chorioamnionitis. PLoS One. 2012;7(12):e51836. DOI: 10.1371/journal.pone.0051836. Epub 2012 Dec 13.[pubmed]

17. Tillett WS, Francis T. Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med. 1930 Sep 30;52(4):561-71.[pubmed]

18. Murray RK. Harper's Illustrated Biochemistry. 28th edition. McGraw-Hill Medical. 2009; ISBN: 0-07-162591-7.

19. Mantovani A, Garlanda C, Doni A, et al. Pentraxins in innate immunity: from C-reactive protein to the long pentraxin PTX3. J Clin Immunol. 2008 Jan;28(1):1-13. DOI: 10.1007/s10875-007-9126-7.[pubmed]

20. McPherson RA, Pincus MR, Henry JB. Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st edition. Philadelphia: Saunders Elsevier, c 2007 ISBN: 9781416002871-1416002871.

21. Wu HC, Shen CM, Wu YY, et al. Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol. 2009 Oct;50(5):217-21. DOI: 10.1016/S1875-9572(09)60066-8.

22. Trochez-Martinez RD , Smith P, Lamont RF Use of C-reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of membranes: a systematic review. BJOG 2007, Jul; 114(7): 796-801; DOI: 10.1111/j.1471-0528.2007.01385.x

23. Guzick DS, Winn K. The association of chorioamnionitis with preterm delivery. Obstet Gynecol. 1985 Jan;65(1):11-6.[pubmed]

24. Asemi Z, Jazayeri S, Najafi M, et al. Effects of daily consumption of probiotic yoghurt on inflammatory factors in pregnant women: a randomized controlled trial. Pak J Biol Sci. 2011 Apr 15;14(8):476-82.[pubmed]

25. Saeedi M, Veghari GR, Marjani A. Seroepidemiologic evaluation of anti-toxoplasma antibodies among women in north of Iran. Pak J Biol Sci. 2007 Jul 15;10(14):2359-62.[pubmed]

26. Sheikhi A.K, Tayade C, Paffaro V.A et al. Are natural killer cells distributed in relationship to nerve fibers in the pregnant mouse uterus? Pak. J. Biol. Sci. 2007, Sep 1; 10(17): 2885-9.[pubmed]

27. Goldenberg RL, Culhane JF, Iams JD, et al. Epidemiology and causes of preterm birth. Lancet. 2008 Jan 5;371(9606):75-84. DOI: 10.1016/S0140-6736(08)60074-4.[pubmed]

28. Holzman C, Lin X, Senagore P, Chung H. et al. Histologic chorioamnionitis and preterm delivery. Am J Epidemiol. 2007 Oct 1;166(7):786-94. DOI: 10.1093/aje/kwm168.[pubmed]

29. Hemalatha R., Ramalakshmi B.A., Quadri S.S.Y.H. et al. Intrauterine growth restriction in term women with histologic chorioamnionitis. Res. J. Obstet. Gynecol. 2008, 1(1): 18-24; DOI: 10.3923/rjog.2008.18.24.

30. Wiwanitkit V. Maternal C-reactive protein for detection of chorioamnionitis: an appraisal. Infect Dis Obstet Gynecol. 2005 Sep;13(3):179-81. DOI:10.1080/10647440500068321.[pubmed]

31. Bańkowska EM, Leibschang J, Pawłowska A. [Usefulness of determination of granulocyte elastase plasma level, c-reactive protein and white blood cell count in prediction in intrauterine infection in pregnant women after PROM]. Ginekol Pol. 2003 Oct;74(10):1037-43.[pubmed]

32. Farb HF, Arnesen M, Geistler P, et al. C-reactive protein with premature rupture of membranes and premature labor. Obstet Gynecol. 1983 Jul;62(1):49-51.[pubmed]

33. Kurki T, Teramo K, Ylikorkala O, et al. C-reactive protein in preterm premature rupture of the membranes. Arch Gynecol Obstet. 1990;247(1):31-7.[pubmed]

34. Gojnic M, Fazlagic A, Pervulov M, et al. The significance of C-reactive protein in the diagnosis of fetal tachycardia and therapy of chorioamnionitis. Clin Exp Obstet Gynecol. 2005;32(2):114-6.[pubmed]

35. Fisk NM, Fysh J, Child AG, et al. Is C-reactive protein really useful in preterm premature rupture of the membranes? Br J Obstet Gynaecol. 1987 Dec;94(12):1159-64.[pubmed]

36. Nowak M, Oszukowski P, Szpakowski M, et al. [Intrauterine infections. I. The role of C-reactive protein, white blood cell count and erythrocyte sedimentation rate in pregnant women in the detection of intrauterine infection after preliminary rupture of membranes]. Ginekol Pol. 1998 Aug;69(8):615-22.

37. Hawrylyshyn P, Bernstein P, Milligan JE, et al. Premature rupture of membranes: the role of C-reactive protein in the prediction of chorioamnionitis. Am J Obstet Gynecol. 1983 Oct 1;147(3):240-6.
Predictive value of maternal C-reactive protein for detection of histological chorioamnionitis in women with prelabor rupture of membranes
DOI: 10.17511/joog.2019.i02.01
Published: 2019-10-16
How to Cite
Naskar, A., & Ghosh, S. (2019). Predictive value of maternal C-reactive protein for detection of histological chorioamnionitis in women with prelabor rupture of membranes. Obs Gyne Review: Journal of Obstetric and Gynecology, 5(2), 83-92.
Original Article