Introduction: The consequences of uncomplicated PPROM are serious, and the presence of overt intraamniotic infection (IAI) is associated with a significant increase in both, the maternal and fetal morbidity and mortality rate. TNF-alpha is a cytokine involved in systemic inflammation and plays an important role in modulating the acute phase reaction.
Aim: The aim of this study was to evaluate the predictive value of TNF-alpha levels in maternal serum within 6 hours after pprom and in the period of up to 12 hours after delivery in the prediction of neonatal and maternal infection.
Material and methods: The investigation was conducted on a group of 56 women diagnosed with PPROM between 30+0 and 36+6 weeks gestational age. In the period of up to 6 hrs from pprom first sample of 10 ml of maternal venous blood for laboratory testing was taken and the level of TNF-alpha was measured. A second sample of venous blood was taken within 12 hrs from delivery to reassess the TNF-alpha levels. All the participants were divided retrospectively into four groups depending on the occurrence of adverse neonatal and maternal outcome. Measuring the concentration of TNF-alpha in maternal serum was performed using the elisa method (enzyme-linked immunosorbent assay).
Results: A statistically significant difference in the second assay (up to 12 hours after delivery) between the patients with and without signs of maternal infection was observed concerning the TNF-alpha serum level. The concentration of this cytokine in maternal serum after delivery was 1.79 and 1.36 pg/ml (p < 0.05) respectively whereas within 6 hours from the PPROM in those two groups it was comparable (1.25 vs. 7.37 pg/ml - ns). Analogous observations were made in case of adverse neonatal outcome, where the TNF-alpha serum level within 12 hours after delivery was 1.70 and 1.45 pg/ml (p < 0.05) and in the period of up to 6 hours from pprom was 1.25 vs. 1.38 pg/ml (ns) respectively
Conclusions: 1. In our investigation the maternal serum TNF-alpha concentration testing within 6 hours from PPROM between 30+0 and 36+6 weeks of gestation did not allow for the identification of patients who are more likely to develop signs of maternal infection and whose infant was at risk of neonatal infection after delivery 2. In case of pprom between 30+0 and 36+6 weeks of gestation maternal serum TNF-alpha concentration testing in the period of up to 12 hours after delivery may be a useful diagnostic tool for identification of patients with an increased risk of maternal and neonatal infection. 3. The lower the gestational age at PPROM and at delivery the risk of neonatal infection was greater.