Diagnosis of intraamniotic inflammation by measuring vaginal interleukin-6 in patients with cervical insufficiency: could amniocentesis be avoided?

Fecha de publicación: 20/01/2022 Fecha Ahead of Print: 20/01/2022

Autores de IIS La Fe

Diana Maria Diago Muñoz

Autor
Alicia Martínez Varea

Autor
Alba Roca Prats

Autor
Ricardo Miguel Alonso Díaz

Autor
Alfredo José Perales Marín

Autor
Vicente Jose Diago Almela

Autor

Grupos

Infecciones Respiratorias

Investigador Principal

Raúl Méndez Ocaña
Medicina Reproductiva

Investigador Principal

José Morales Roselló

Abstract

BACKGROUND: Cervical insufficiency is a recurrent, passive, and painless dilation of the cervix in the second trimester. The etiology is unclear, but there may be an association with subclinical intraamniotic infection. Interleukin-6 (IL-6) production in the amniotic cavity is induced by bacterial invasion, it is the major proinflammatory cytokine released in response to infection. Although the gold standard method to measure it is through an amniocentesis, the procedure constitutes an invasive technique with several associated risks. The objective of this study is to determine if there is a correlation between intraamniotic and vaginal IL-6 in patients with cervical insufficiency and bulging membranes during the second trimester of pregnancy, in order to avoid an amniocentesis before the rescue cerclage. METHODS: A cohort study was performed in which all patients with cervical insufficiency and bulging membranes admitted into our tertiary hospital between 2019 and 2020 were included, and a control group of asymptomatic women in the second trimester of gestation where studied at the same time. Patients with bulging membranes underwent an amniocentesis to quantify amniotic IL-6, and a sample of vaginal fluid for vaginal IL-6 determination was obtained from both the study and the control group. RESULTS: A total of 20 women were included in each group. Median gestational age at diagnosis was 22 weeks in patients with bulging membranes, and 21 weeks in the control group. Vaginal IL-6 in control group (10.875 pg/mL) is much lower than the study group one (1308.77 pg/ml). In patients with bulging membranes, vaginal IL-6 expression was lower in the vagina than in the amniotic cavity [average IL-6 in the amniotic cavity 26890.07 pg/mL, vs 1308.77 pg/mL in the vagina (p < .01)]. Through a Spearman coefficient correlation rank [rho = 0.709 (p < .001)], there is a positive correlation between amniotic and vaginal IL-6 values. The best value of this correlation was calculated with the ROC curve, being the area under the curve 0.929 (CI 95% 0.721-0.995), and the cutoff of point less than 61.4 pg/ml (sensitivity 83.33%; specificity 92.86%). Patients with vaginal IL-6 < 61.4 pg/ml associated a longer latency time between diagnosis and delivery, a higher neonatal weight and a lower perinatal mortality. Rescue cerclage in vaginal IL-6 < 61.4 pg/ml was the best predictor of good pregnancy outcome. CONCLUSION: There is a correlation between intraamniotic and vaginal IL-6 in patients with cervical insufficiency and bulging membranes during the second trimester of pregnancy. However, further studies are needed in order to considerate the avoidance of an amniocentesis before an emergency cerclage.

Datos de la publicación

ISSN/ISSNe:: 1476-7058, 1476-4954
Tipo:: Article
Páginas:: 1-5
DOI:: 10.1080/14767058.2022.2029838
Factor de Impacto:: 0,610 SCImago ℠
Cuartil:: Q2 SCImago ℠

Documentos

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Métricas

Filiaciones

Diago Muñoz DM:: Departament of Obstetrics and Gynecology, Hospital General Universitario Santa Lucía, Cartagena, Spain
Martinez-Varea, Alicia:: Departament of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Roca Prats, Alba:: Departament of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Alonso-Diaz, Ricardo:: Departament of Clnical Laboratory, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Perales Marin, Alfredo:: Departament of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Diago Almela, Vicente Jose:: Departament of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain

Keywords

Cervical insufficiency; interleukin-6 (IL-6); intraamniotic IL-6; intraamniotic inflammation; vaginal IL-6

Campos de estudio

Proyectos asociados

APLICACION DE TECNICAS LAPLACIANAS PARA LA MONITORIZACION DE LA ACTIVIDAD ELECTRICA DEL MUSCULO LISO HUMANO:ENFASIS EN ELECTROHISTEROGRAMA (LAMOHIS)

Investigador Principal: ALFREDO JOSÉ PERALES MARÍN

LAMOHIS PLAN NACIONAL I+D+I 2008-2011 . 2010

UTILIDAD DEL TRATAMIENTO TOCOLITICO DE MANTENIMIENTO EN EL MANEJO DE LA AMENAZA DE PARTO PREMATURO (APP)

Investigador Principal: MÁXIMO VENTO TORRES

EC11-246 . 2012

BIOMARCADORES INFLAMATORIOS Y CARDÍACOS COMO PREDICTORES DE EVENTOS CARDIOVASCULARES Y MORTALIDAD TRAS EL ALTA EN LA NEUMONÍA ADQUIRIDA EN LA COMUNIDAD.

Investigador Principal: ROSARIO MENÉNDEZ VILLANUEVA

PI13/00583 . INSTITUTO DE SALUD CARLOS III . 2014

CON-CIENCIA-YV: PILDORAS DE SALUD

FCT-13-7457_FECYT_2013 . MINISTERIO DE ECONOMIA Y COMPETITIVIDAD; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2013