Utility of Amniotic Fluid Biomarkers to Predict Preterm Delivery for Clinical Chorioamnionitis in Women With Intact Membranes.

BACKGROUND

Clinical chorioamnionitis is a major contributor to preterm birth and neonatal morbidity. Diagnosis in women with intact membranes is challenging, particularly in the subclinical phase where maternal signs are subtle and conventional serum markers are limited in predictive value.

AIMS: To evaluate the diagnostic performance of selected novel amniotic fluid biomarkers (interleukin-6, interleukin-10, tumour necrosis factor-ɑ, matrix metalloproteinase-8), and conventional amniotic and serum biomarkers in predicting delivery for clinical chorioamnionitis within 14 days of amniocentesis in women with suspected subclinical infection and intact membranes.

MATERIALS AND

METHODS

A prospective cohort study was conducted at a single Australian tertiary hospital. Thirty-two women with singleton pregnancies and suspected subclinical chorioamnionitis underwent amniocentesis. Amniotic fluid and serum were analysed for selected biomarkers. The primary outcome was delivery for clinical chorioamnionitis within 14 days of amniocentesis. ROC curves were constructed to assess biomarker performance.

RESULTS

Delivery for clinical chorioamnionitis occurred in 11 of 31 evaluable cases (35%). Matrix metalloproteinase-8, lactate dehydrogenase, and glucose were the strongest predictors (area under the curve (AUC) of 0.93 (95% CI 0.85-1.0), 0.93 (95% CI 0.85-1.0), and 0.92 (95% CI 0.8-1.0) respectively). Amniotic fluid biomarkers outperformed serum markers (C-reactive protein AUC 0.70 (95% CI 0.49-0.91) and white cell count AUC 0.67 (95% CI 0.46-0.86)). Novel amniotic fluid biomarkers did not demonstrate superior diagnostic performance over conventional amniotic fluid biomarkers including lactate dehydrogenase and glucose.

CONCLUSIONS

Amniotic fluid biomarkers show promise in identifying women with subclinical chorioamnionitis. These findings support further validation of scalable biomarker-based testing to guide early intervention and improve perinatal outcomes.