조기진통임산부에서 C-Reactive Protein검사의 임상적 의의 및 태반조직학적 변화와의 관계 = C-Reactive Protein in Preterm Labor: Clinical Significance and Placental Histology

다국어 초록 (Multilingual Abstract)

A test to detect the subclinical intrauterine infection with intact membrane in pretem labor would be helpful in its treatment and would make it possible to prolong the pregnancy, thus allowing the minimizing the sequelae of prematurity and infection. We performaed the qualitative test of serum C-reactive protein(CRP)in 105 cases ofpreterm labor with intact membrane between 24-35 gestational weeks and 25 cases of term labor in 38-42 gestational weeks, who were admitted to the department of Obstetrics and Gynecology of Ewa Womans University Hospital from January 1st, 1991 to August 31st, 1992. The study groups were catagorized to three groups according to the result of CRP, that is 34 cases of CRP positive preterm labor patient (group Ⅰ),71 cases of CRP negative preterm labor patients (group Ⅱ), and 25 cases of term labor women (group Ⅲ) as a control group. The results were as follows: 1. The prevalence of positive CRP was 32.4% in preterm labor women and 24.0% in term labor women. There was no significant difference between them. 2. The gestational weeks at admission of group Ⅰ was significantly shorter than that of group Ⅱ (31.0+_0.6 weeks: 32.3+_03 weeks). The delay of time from admission to delivery and gestational weeks at delivery in group Ⅰ were shorter than those in group Ⅱ(7.1+_2.5 days: 25.9+_3.2days, 31.9+_0.7 weeks: 36.1+_0.4 weeks) 3. White blood cell count at admission of group Ⅰ was 14159+_1005/mm3,which was significantly higher than that of group Ⅱ(11437+_394/mm3)and group Ⅲ(11420+_719/mm3). The microorganism from uterine cervix was isolated in 46.7% and 53.8% in group Ⅰ and ii with no difference between groups. 4. In perinatal outcome, the mean birth weight, one minute, and five minute Apgar score of group Ⅰ were significantly lower than those of group Ⅱ(1795+_146g: 2621+_81g, 6.1+_0.6:8.3+_0.2, 7.1+_0.6:9.3+_0.2). The perinatal morbidity and mortality of group Ⅰ were significantly higher than those of groupⅡ(44.1%:29.6%,23.5%:4.2%). 5. In preterm labor patients who were administerde tocolytics, the delay of time from the initiation of treatment to delivery and the gestational weeks at delivery were significantly shorter in CRP positive group than in CRP negative group(14+_5.7 days:30.0+_4.2days,31.6+_1.4weeks:36.7+_0.5weeks)and the treatment success rate was significantly lower in CRP positive group than in CRP negative group(35.7%:75%) The sensitivity and specificity of CRP as a test to predict failed tocolytics were 64.3% and 75%. 6. Pathologic placental infection was found in 100% of preterm labor patients and in 76% of term labor women, Moreover, more severe placental infection(stageⅢ chorioamniontis)predominated in group Ⅰ, comparing to group Ⅱ and Ⅲ(52.6%:12%:4%). Based on above results CRP test in preterm labor patitnts is helpful for diagnosis of sublinica intrauterine infection and predicting the pregnancy outcome.