Korean food is being recognized for its excellence. This paper attempts to provide material for the popularization of Korean cuisine with respect to foreign nationals living in Korea who are vegetarian by studying their Korean cuisine knowledge and preferences. The results of an Importance-Performance Analysis showed that though the importance values of traditional spice use such as garlic and the consideration of ingredient price were high, their performance values were low. Thus, these were areas identified as needing major improvement. Repeated measured data analysis was performed to determine variations in the perception of major factors for the development of Korean cuisine. The results indicated that simplification of seasoning was the most important factor followed by diversification of food ingredients, resale of vegetables in small quantities, ease of obtaining Korean cuisine recipes, and popularization of herbal and temple food, in that order. The least important factor in developing Korean cuisine was determined to be the reduction in levels of salt. Conjoint analysis was performed on the choices affection the selection of Korean cuisine, and price was found to be the most important factor. It was also determined that the effectiveness in the combination of fusion style, health oriented, concurrently served, medium to low price Korean cuisine was highest in preference. The next highest preferred combination was traditional style, health oriented, concurrently served, medium to low price Korean cuisine. The most significant factor to keep in mind in developing Korean dishes for foreign vegetarians was determined to be price. Furthermore, it was important to not simply reduce caloric intake but to use healthy ingredients and cooking methods.

AIMS:The purpose of this study was to determine the clinical significance of detecting microbial footprints of ureaplasmas in amniotic fluid (AF) using specific primers for the polymerase chain reaction (PCR) in patients presenting with cervical insufficiency. METHODS:Amniocentesis was performed in 58 patients with acute cervical insufficiency (cervical dilatation, > or =1.5 cm) and intact membranes, and without regular contractions (gestational age, 16-29 weeks). AF was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. Ureaplasmas (Ureaplasma urealyticum and Ureaplasma parvum) were detected by PCR using specific primers. Patients were divided into three groups according to the results of AF culture and PCR for ureaplasmas: those with a negative AF culture and a negative PCR (n=44), those with a negative AF culture and a positive PCR (n=10), and those with a positive AF culture regardless of PCR result (n=4). RESULTS:1) Ureaplasmas were detected by PCR in 19.0% (11/58) of patients, by culture in 5.2% (3/58), and by culture and/or PCR in 22.4% (13/58); 2) Among the 11 patients with a positive PCR for ureaplasmas, the AF culture was negative in 91% (10/11); 3) Patients with a negative AF culture and a positive PCR for ureaplasmas had a significantly higher median AF matrix metalloproteinase-8 (MMP-8) concentration and white blood cell (WBC) count than those with a negative AF culture and a negative PCR (P<0.001 and P<0.05, respectively); 4) Patients with a positive PCR for ureaplasmas but a negative AF culture had a higher rate of spontaneous preterm birth within two weeks of amniocentesis than those with a negative AF culture and a negative PCR (P<0.05 after adjusting for gestational age at amnio-centesis); 5) Of the patients who delivered within two weeks of amniocentesis, those with a positive PCR for ureaplasmas and a negative AF culture had higher rates of histologic amnionitis and funisitis than those with a negative AF culture and a negative PCR (P<0.05 after adjusting for gestational age at amniocentesis, for each); 6) However, no significant differences in the intensity of the intra-amniotic inflammatory response and perinatal outcome were found between patients with a positive AF culture and those with a negative AF culture and a positive PCR. CONCLUSIONS:1) Cultivation techniques for ureaplasmas did not detect most cases of intra-amniotic infection caused by these microorganisms (91% of cases with cervical insufficiency and microbial footprints for ureaplasmas in the amniotic cavity had a negative AF culture); 2) Patients with a negative AF culture and a positive PCR assay were at risk for intra-amniotic and fetal inflammation as well as spontaneous preterm birth.

Objective: Previous studies reported that the clinical significance of intra-amniotic inflammation with a negative amniotic fluid (AF) culture is similar to that of intra-amniotic inflammation with microbiologically-proven AF infection. However, the magnitude of the fetal inflammatory response in these two conditions is different as gauged by umbilical cord C-reactive protein (CRP) concentrations. We undertook this study to determine if the frequency of oligohydramnios is different in these two conditions. Methods: The amniotic fluid index (AFI) was measured in 205 patients with preterm premature rupture of membranes (PROM) (F35 weeks). AF was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. Intra-amniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 (MMP-8) concentration ()23 ng/mL). Patients were divided into three groups according to the results of AF culture and the presence or absence of intraamniotic inflammation: 1) without intra-amniotic inflammation and a negative culture (ns109); 2) with intra-amniotic inflammation and a negative culture (ns44); and 3) a positive culture (ns52). *This study was presented at the 28 Annual Clinical Meeting of the Society for Maternal–Fetal Medicine, Dallas, TX, January 28–February 2, 2008. This work was supported in part by Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MOST) (No. R01-2006-000-10607-0) and in part by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS. **Corresponding author: Bo Hyun Yoon, MD, PhD Department of Obstetrics Gynecology College of Medicine Seoul National University Seoul 110-744 Korea Tel.: q82-2-2702-2826 Fax: q82-2-765-3002 E-mail: Yoonbh@snu.ac.kr Results: Patients with a positive culture had a higher frequency of oligohydramnios and a lower median AFI than those with a negative culture but with intra-amniotic inflammation (P-0.01). However, there was no significant difference in the median AFI or in the frequency of oligohydramnios according to the presence or absence of intraamniotic inflammation among patients with a negative culture (P)0.1). Conclusion: Oligohydramnios was more frequent in patients with culture-proven AF infection than in those with intraamniotic inflammation and a negative AF culture.

Objective: This study was conducted to examine the frequency and clinical significance of a positive Amnisure test in patients with preterm labor and intact membranes by sterile speculum exam. Study design: A retrospective cohort study was performed including 90 patients with preterm labor and intact membranes who underwent Amnisure tests prior to amniocentesis (< 72 h); most patients (n = 64) also underwent fetal fibronectin (fFN) tests. Amniotic fluid (AF) was cultured for aerobic/anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8. Results: (1) the prevalence of a positive Amnisure test was 19% (17/90); (2) patients with a positive Amnisure test had significantly higher rates of adverse pregnancy and neonatal outcomes (e.g., impending preterm delivery, intra-amniotic infection/inflammation, and neonatal morbidity) than those with a negative Amnisure test; (3) a positive test was associated with significantly increased risk of intra-amniotic infection and/or inflammation, delivery within 7, 14, or 28 days and spontaneous preterm birth (< 35 weeks) among patients with a negative fFN test. Conclusions: A positive Amnisure test in patients with preterm labor and intact membranes is a risk factor for adverse pregnancy outcome, particularly in patients with a negative fFN test. A positive Amnisure test in patients without symptoms or signs of ROM should not be taken as an indicator that membranes have ruptured.

Objective. This study was performed to evaluate the relationship among the Nugent score for the diagnosis of bacterial vaginosis (BV), the results of vaginal fluid culture for genital mycoplasmas, and the subsequent occurrence of preterm birth. Methods. The Nugent score and culture for genital mycoplasmas were performed in vaginal fluid obtained from 977 pregnant women (gestational age 13-30 weeks). Vaginal samples were obtained with sterile cotton swabs. The relationship among the Nugent score, vaginal fluid culture results and the occurrence of spontaneous preterm birth was examined. Results. (1) Of the 977 women, 14% (137) had a Nugent score of 8; (2) The prevalence of a positive vaginal culture for genital mycoplasmas was 30% (288); Ureaplasma urealyticum was isolated in 252 (88%), Mycoplasma hominis in 9 (3%), and both in 27 (9%) women; (3) Cases with a Nugent score of 8 had a higher rate of a positive vaginal culture for genital mycoplasmas than those with the lower Nugent score (55%vs. 25%; p0.001); (4) Women with a Nugent score of 8 had a significantly higher rate of spontaneous preterm birth 37 (10%vs. 4%), 34 (5%vs. 2%), and 32 (4%vs. 1%) weeks of gestation than those with the lower Nugent score (at each gestational age, p0.05); (5) In contrast, a positive vaginal culture for genital mycoplasmas was not associated with an increased risk for spontaneous preterm birth; (6) Among patients with a positive culture and a Nugent score of 8, the frequency of spontaneous preterm delivery (37 weeks) was 10% (7/72); (7) There was no difference in the incidence of spontaneous preterm delivery according to the results of vaginal culture in patients with a Nugent score of 8, as well as in those with a lower Nugent score. Conclusion. A high Nugent score (8) for the detection of BV but not a positive vaginal culture for genital mycoplasmas is a risk factor for spontaneous preterm birth.

Objective. To determine whether amniotic fluid (AF) concentration of prostaglandins (PGs) increases in patients with intra-amniotic inflammation and/or proven AF infection in preterm PROM, and can predict impending delivery.Methods. AF PGF2a concentrations were determined by ELISA in 140 singleton pregnancies with preterm premature rupture of membranes (PROM) (≤35 weeks). AF was cultured for aerobic and anaerobic bacteria, and genital mycoplasmas. Intra-amniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 concentration (>23 ng/ml).Results. (1) Patients with intra-amniotic inflammation and a negative AF culture had a significantly higher median AF PGF2a than those without intra-amniotic inflammation and with a negative culture (p < 0.001); (2) However, there was no difference in the median AF PGF2a between patients with intra-amniotic inflammation with a negative culture and those with culture-proven AF infection (p > 0.1); (3) Patients with an elevated AF PGF2a had a significantly shorter interval-to-delivery than those with a low AF PGF2a (≤170 pg/mL) (p < 0.001); (4) An elevated AF PGF2a (≤170 pg/mL) concentration was a significant predictor of the duration of pregnancy after adjusting for gestational age and AF inflammation/infection (p < 0.005).Conclusions. AF PGF2a (≥170 pg/mL) concentration increased in patients with intra-amniotic inflammation regardless of AF culture results. Moreover, an elevated AF PGF2a concentration was an independent predictor of impending delivery in preterm PROM.

Objective: The purpose of this study was to determine 1) insulin-like growth factor binding protein-1 (IGFBP1) in amniotic fluid (AF)exhibited proteolytic cleavage in cases of intra-amniotic inflammation; and 2) if the matrix metalloproteinases (MMP-3, MMP-8, MMP-9) in AF are associated with the degradation of IGFBP-1 in AF.Methods: AF samples (n=20) were obtained from preterm gestations with and without intra-amniotic inflammation. The form of IGFBP-1 in AF was assessed by Western blot analysis and AF MMP-8 concentration was measured by ELISA. Densitometric analysis of Western blot was performed and the fragmented/intact IGFBP-1 ratio was calculated. Proteolysis of AF IGFBP-1 by MMPs was evaluated by incubating AF with exogenous human MMP-3, MMP-8 or MMP-9, and by incubating recombinant human IGFBP-1 in AF with and without inflammation.Results: 1) IGFBP-1 was present in AF without inflammation as an intact form; however, the fragmented form was dominant in AF with inflammation; 2) the ratio of fragmented/intact IGFBP-1 was significantly higher in AF with inflammation than in AF without inflammation; 3) a higher ratio of fragmented/intact IGFBP-1 was associated with a higher concentration of MMP-8; 4) in-vitro proteolysis experiments showed that AF IGFBP-1 was degraded by exogenous human MMP-3, MMP-8 and MMP-9; 5) recombinant human IGFBP-1 was fragmented in AF with inflammation, but not in AF without inflammation.Conclusion: The fragmented form of AF IGFBP-1 was significantly increased in AF with intra-amniotic inflammation were associated with the proteolytic change of AF IGFBP-1.

OBJECTIVE: The purpose of this study was to determine the frequency and clinical significance of intraamniotic inflammation in patients with acute cervical insufficiency.STUDY DESIGN: Amniocentesis was performed in 52 patients with acute cervical insufficiency (cervical dilation, >= 1.5 cm) and intact membranes and without regular uterine contractions (gestational age, 17-29 weeks). Amniotic fluid (AF) was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8. Intraamniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 concentration (> 23 ng/mL). Nonparametric statistics and survival techniques were used for analysis.RESULTS: The prevalence of intraamniotic inflammation was 81% (42/52); the prevalence of a positive AF culture was 8% (4/52). Intraamniotic inflammation was present in all cases with a positive AF culture. Preterm delivery within 7 days occurred in 50% of cases (19/38), and delivery before 34 weeks of gestation occurred in 84% of cases (32/38) with intraamniotic inflammation but without AF infection. Fifty-five percent of newborn infants (21/38) who were born to mothers with intraamniotic inflammation but without AF infection died immediately after birth (< 1 day). The amniocentesis-to-delivery interval was shorter in patients with intraamniotic inflammation than in those without inflammation (P < .05). There were no differences in the interval-to-delivery or the rate of adverse outcome between patients with intraamniotic inflammation and a negative culture and patients with proven AF infection.CONCLUSION: Intraamniotic inflammation, regardless of AF culture result, is present in approximately 80% of patients with acute cervical insufficiency and is a risk factor for impending preterm delivery and adverse outcomes.

Objectives. The role of prostaglandins (PGs) in the onset of human parturition has been controversial. Specifically, some investigators have proposed that PGs are the consequence rather than the cause of labor. An important question is whether or not amniotic fluid (AF) PG concentrations increase before the onset of labor in humans.Methods. The concentrations of PGs were determined in AF obtained from 167 singleton pregnant women with intact membranes. Patients were divided into four groups: (1) preterm not in labor (gestational age 15–36 weeks, n = 65); (2) term not in labor (n = 68); (3) spontaneous labor at term with cervical dilatation <4 cm (n = 25); (4) spontaneous labor at term with cervical dilatation ≥4 cm (n = 9). AF was obtained by transabdominal amniocentesis or collected at the time of cesarean delivery. All patients met the following criteria: (1) normal pregnancy outcome; (2) clear AF; (3) no significant medical or obstetric complications such as diabetes mellitus, preeclampsia, preterm birth, fetal growth restriction, or major congenital malformations; and (4) no significant neonatal complications. The concentrations of PGE2 and PGF2a in AF were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric analysis was performed.Results. (1) AF PG concentrations remained unchanged with advancing gestation until 36 weeks of gestation; (2) however, an abrupt increase in AF PG concentrations was observed before the onset of labor at term; (3) among cases without labor at term, the median AF PGF2a concentration increased with advancing gestation; (4) the presence of labor and the degree of cervical dilatation were significantly associated with a higher concentration of PGF2a.Conclusions. An abrupt increase in AF PG concentrations (25-fold for PGF2a) occurs before the onset of spontaneous labor at term in humans; these observations suggest that PGs increase prior to the onset of labor and contradict the claim that an increase in PG concentrations is the consequence of labor.

OBJECTIVE: The amniotic cavity is normally sterile for bacteria. However, experimental evidence indicates that regular uterine contractions exert a suction-like effect whereby vaginal fluid ascends into the uterine cavity with contractions (demonstrated by sonohysterography contrast media). Consequently, this study was conducted to determine whether the presence and progress of labor are associated with an increased risk of microbial invasion of the amniotic cavity (MIAC), intraamniotic inflammation, and histologic chorioamnionitis in women with term pregnancies with intact membranes.STUDY DESIGN: Amniotic fluid (AF) was obtained from term singleton pregnant women with intact membranes at the time of cesarean delivery. AF was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and white blood cell (WBC) count was determined. Patients were divided into 3 groups according to the presence or absence of labor and the progress of labor. Nonparametric statistics were used for analysis.RESULTS: Results included: (1) a total of 884 pregnant women were enrolled and divided into 3 groups: group 1, not in labor (n = 775); group 2, in early labor (cervical dilatation less than 4 cm) (n = 86); and group 3, in active labor (cervical dilatation 4 cm or greater) (n = 23); (2) the frequency of MIAC was 1% (6 of 775) in women not in labor, 3.5% (3 of 86) in patients with early labor, and 13% (3 of 23) in patients with active labor; and (3) the median AF WBC count and the frequency of histologic chorioamnionitis were also higher in the presence of labor than in the absence of labor.CONCLUSION: We came to the following conclusions: (1) labor is associated with an increased risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis in term pregnancy with intact membranes; (2) the more advanced the cervical dilatation, the greater the risk of MIAC, a higher median AF WBC count, and histologic chorioamnionitis; and (3) in contrast, fetal inflammation (funisitis) did not increase with the presence of labor or as a function of cervical dilatation. We propose that labor predisposes to MIAC, a higher median AF WBC count, and histologic chorioamnionitis.

Previous studies have claimed that the clinical significance of intra-amniotic inflammation (IAI) with a negative culture for microorganisms is similar to that of IAI with microbiologically-proven amniotic fluid (AF) infection. However, infection, which is severe enough to yield a positive culture, may have different implications on the fetus and its organ systems (i.e., urinary tract and urine production). The purpose of this study was to determine if proven AF infection is associated with changes in AF volume. A cohort of 205 singleton pregnancies with preterm PROM (≤35 weeks) was assembled. AF volume was measured with AFI. AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas. IAI was defined as an elevated AF MMP-8 concentration (>23 ng/mL). Patients were divided into three groups according to the results of AF culture and the presence or absence of IAI; 1) without IAI and a negative AF culture (N=109); 2) IAI and a negative AF culture (N=44); 3) positive AF culture (N=52). 1) The overall frequency of oligohydramnios (AFI≤5 cm) was 29% (59/205); 2) Patients with a positive AF culture had a higher frequency of oligohydramnios and lower median AFI than those with negative culture but with IAI (46% vs 16%; p<.005, 5.1 vs 8.4; p<.01); 3) However, there was no significant difference in the frequency of oligohydramnios and median AFI depending on the presence or absence of IAI among patients with a negative AF culture (p>.1); 4) Among patients with a positive AF culture, those with oligohydramnios had a shorter interval-to-delivery than those without oligohydramnios (p<.001). 1) Oligohydramnios is associated with proven AF infection; 2) Oligohydramnios is a risk factor for impending preterm delivery; 3) We propose that among patients with proven AF infection, those with oligohydramnios have the most advanced stage of the fetal inflammatory response syndrome.

LEE, JI HYUN KANG, JOONHO LEE, JONG KWAN JUN, BO HYUN YOON, Seoul National University College of Medicne, Obstetrics and Gynecology, Seoul, South Korea OBJECTIVE: To determine whether AF PG increases in patients with intra-amniotic inflammation(IAI) and/or proven AF infection and if it is a predictor of impending delivery in preterm PROM STUDY DESIGN: AF PGF2a concentrations were determined by ELISA in 140 singleton pregnancies with preterm PROM( 35 weeks). AF was cultured for aerobic/anaerobic bacteria and mycoplasmas. IAI was defined as an elevated AF MMP-8 concentration( 23 ng/mL) RESULTS: 1) Patients with IAI and with a negative AF culture had significantly higher AF PGF2a concentrations than those without IAI and with a negative culture(p .001); 2) However, there was no difference in AF PGF2a concentrations between patients with IAI and with a negative culture and those with AF infection(p .4); 3) AF PGF2a 170 pg/mL has a sensitivity of 63% and a specificity of 89% in the identification of IAI and/or AF infection; 4) Patients with high AF PGF2a( 170 pg/mL) had significantly shorter interval-to-delivery than those with low AF PGF2a(p .001); 5) High AF PGF2a concentration was a significant predictor of the duration of pregnancy after adjustment for gestational age and AF inflammation/infection(OR, 2.3; 95% CI, 1.4-4.0; p .005). CONCLUSION: AF PGF2a increased in patients with IAI regardless of AF infection. Moreover, high AF PGF2a concentration was an independent predictor of impending delivery in preterm PROM.

The amniotic cavity is normally sterile for bacteria. However, experimental evidence indicates that regular uterine contractions exert a "suction-like effect" whereby vaginal fluid ascends into the uterine cavity with each contraction (demonstrated by sonohysterography contrast media). Consequently, this study was conducted to determine whether the presence and progress of labor are associated with an increased risk of amniotic fluid(AF) infection, AF inflammation and histologic chorioamnionitis in women with term pregnancies with intact membranes. AF was obtained from 884 singleton pregnant women at term with intact membranes at the time of cesarean delivery. AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas and white blood cell (WBC) count was determined. Patients were divided into 3 groups: Group 1–not in labor(n=775); Group 2–in early labor(cervical dilatation<4cm)(n=86); Group 3–in active labor(cervical dilatation≥4cm)(n=23). Nonparametric statistics were used. The presence of labor, as well as the degree of labor (as gauged by cervical dilatation) were associated with a higher rate of AF infection and histologic chorioamnionitis as well as a higher median AF WBC count than the absence of labor (p<0.01 for each;see Table).Tabled 1No labor (n = 775)Early labor (n = 86)Active labor (n =23)PPositive AFculture6 (0.8%)3 (3.5%)3 (13.0%)<.001AF WBC count (median and range)2 (0->1000)3 (0->1000)10 (0->1000)<.005Histologicchorioamnionitis31 (4.0%)10 (11.6%)7 (30.4%)<.001Funisitis8 (1.0%)2 (2.3%)0 (0%)>.1 Open table in a new tab Labor per se is associated with an increased risk of AF infection, AF inflammation and histologic chorioamnionitis in term pregnancy with intact membranes; The more advanced the labor process, the greater the risk of AF infection, inflammation, and histologic chorioamnionitis; However, this does not apply to fetal inflammation (funisitis); Spontaneous labor at term with intact membranes predisposes to intrauterine infection.

To determine if an elevated concentration of a cervical fetal fibronection (FFN) is a risk factor for amniotic fluid (AF) infection, AF inflammation, histologic chorioamnionitis and shorter amniocentesis-to-delivery interval in patients with preterm labor and intact membranes. Cervical FFN test was performed in 124 singleton pregnant women (≤35 weeks of gestation) with preterm labor and intact membranes at the time of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas. AF inflammation was defined as an elevated AF matrix metalloproteinase-8 (MMP-8) concentration (>23 ng/mL). Nonparametric tests and survival techniques were used for analysis. 1) Patients with an elevated FFN had a significantly lower gestational age at birth, shorter amniocentesis-to-delivery interval and higher median AF MMP-8 and higher rates of a positive AF culture, AF inflammation and spontaneous preterm delivery within 7 days and 2 weeks than those without an elevated FFN (p<.05 for each); 2) A FFN of ≥150 ng/mL had a better diagnostic performance in the identification of both AF inflammation and spontaneous preterm delivery than did a FFN of ≥50 ng/mL (p<.05 for specificity for each); 3) However, there was no significant relationship between an elevated FFN and histologic chorioamnionitis (p>.05); 4) Multivariate survival analysis indicated that both AF inflammation and a FFN of ≥150 ng/mL (but not ≥50 ng/mL) were associated with short latency periods (hazards ratio, 2.05 and 4.36; 95% confidence interval, 1.21-3.46 and 2.28-8.34, respectively; p< .01). An elevated FFN was associated with short amniocentesis-to-delivery interval and AF inflammation but not with histologic chorioamnionitis in patients with preterm labor and intact membranes. A FFN of ≥150 ng/mL had better diagnostic and prognostic performance than did a FFN of ≥50 ng/mL.

OBJECTIVE: To compare the accuracy of an immunoassay to measure levels of placental alpha-microglobulin-1 in cervicovaginal secretions with that of conventional clinical assessment for the diagnosis of rupture of membranes. METHODS: A prospective observational study was performed in consecutive patients with signs or symptoms of rupture of membranes at Seoul National University Hospital from March 2005 to February 2006. Initial evaluation included both the standard clinical evaluation for rupture of membranes and placental alpha-microglobulin-1 immunoassay. Rupture of membranes was diagnosed if fluid was seen leaking from the cervical os or if two of the following three conditions were present: pooling of fluid, positive nitrazine test, or ferning. Rupture of membranes was diagnosed definitively on review of the medical records after delivery. RESULTS: Of 184 patients (11–42 weeks of gestation), rupture of membranes was diagnosed at initial presentation in 76% (139 of 184) using conventional clinical assessment and 88% (161 of 184) using placental alpha-microglobulin-1 immunoassay. Follow-up confirmed that a total of 159 of 183 patients (87%) had rupture of membranes at their initial presentations. Using this longitudinal assessment as the clinical gold standard, placental alpha-microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 98.7% (157 of 159), specificity of 87.5% (21 of 24), positive predictive value of 98.1% (157 of 160), and negative predictive value of 91.3% (21 of 23). Placental alpha-microglobulin-1 immunoassay was better than both the conventional clinical assessment and the nitrazine test alone in confirming the diagnosis of rupture of membranes. CONCLUSION: Measurement of placental alpha-microglobulin-1 in cervicovaginal secretions is superior to conventional clinical assessment in the diagnosis of rupture of membranes. LEVEL OF EVIDENCE: II

OBJECTIVE:Intraamniotic inflammation is a risk factor for adverse pregnancy and neonatal outcome, regardless of the presence or absence of a positive amniotic fluid (AF) culture. The purpose of this study was to determine whether the intensity of a fetal inflammatory response (FIR) differs between cases of intraamniotic inflammation with microbiologically proven infection and cases with negative AF cultures. STUDY DESIGN:The FIR was examined in 89 cases of women with preterm premature rupture of membranes who delivered singleton preterm newborn infants within 48 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas. AF white blood cell (WBC) count and matrix metalloproteinase-8 (MMP-8) determinations were performed to assess the presence of intraamniotic inflammation. Intraamniotic inflammation was defined as an elevated AF MMP-8 concentration (>23 ng/mL). The intensity of the FIR was determined by the umbilical cord plasma concentrations of C-reactive protein (CRP). Patients were divided into 3 groups according to the presence or absence of intraamniotic inflammation and AF culture results: group 1, without intraamniotic inflammation and with a negative AF culture (n = 28); group 2, with intraamniotic inflammation and with a negative AF culture (n = 26); group 3, with a positive AF culture (n = 35). RESULTS:Neonates who were born to mothers with intraamniotic inflammation and negative AF cultures had a significantly higher median umbilical cord plasma CRP concentration than did those without intraamniotic inflammation and a negative AF culture (P < .005) but a significantly lower median cord plasma CRP concentration than did those with proven AF infection (P < .05). Patients with intraamniotic inflammation and a negative AF culture had significantly higher median AF MMP-8 concentrations and WBC count than did those without intraamniotic inflammation and a negative AF culture (P < .001). However, there was no significant difference in the median AF MMP-8 and WBC count between patients with intraamniotic inflammation and a negative AF culture and those with proven AF infection (MMP-8, P > .1, and WBC, P = .09). CONCLUSION:Intraamniotic inflammation without documented AF infection is a risk factor for a systemic FIR. However, the magnitude of the FIR in those cases was lower than in those with documented AF infection.

ObjectiveTo determine if the intensity of a fetal inflammatory response (FIR) is different in cases of IAI with proven amniotic fluid (AF) infection and cases with IAI with negative AF cultureStudy designThe FIR was examined in 89 cases of PPROM who delivered singleton preterm newborns within 48 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and mycoplasmas. AF inflammation was defined as an elevated AF MMP-8 concentration (>23 ng/mL). The intensity of the FIR was examined by the umbilical cord plasma concentrations of C-reactive protein (CRP). Patients were divided into 3 groups according to the presence or absence of inflammation and AF culture results; 1) without inflammation and a negative AF culture (N=28); 2) with inflammation and a negative AF culture (N=26); 3) with a positive AF culture (N=35).Results1) Newborns born to mothers with IAI but with a negative AF culture had a significantly lower median umbilical cord plasma concentration of CRP than those with proven AF infection (median, 43 ng/ml; range, 5-4305 ng/ml; vs median, 285 ng/ml; range, 18-4534 ng/ml; p<.05). but a significantly higher median cord plasma CRP than those without IAI and a negative AF culture (p<.005); 2) Patients with IAI but with a negative AF culture had significantly higher median AF MMP-8 and WBC count than those without IAI and a negative AF culture (p<.001).ConclusionIAI in cases without documented AF infection is a risk factor for a systemic FIR. However, the magnitude of the FIR in those cases was lower than that in those with documented AF infection. These observations have implications for the implementation of strategies to detect IAI and infection as well as for the treatment of newborns. ObjectiveTo determine if the intensity of a fetal inflammatory response (FIR) is different in cases of IAI with proven amniotic fluid (AF) infection and cases with IAI with negative AF culture To determine if the intensity of a fetal inflammatory response (FIR) is different in cases of IAI with proven amniotic fluid (AF) infection and cases with IAI with negative AF culture Study designThe FIR was examined in 89 cases of PPROM who delivered singleton preterm newborns within 48 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and mycoplasmas. AF inflammation was defined as an elevated AF MMP-8 concentration (>23 ng/mL). The intensity of the FIR was examined by the umbilical cord plasma concentrations of C-reactive protein (CRP). Patients were divided into 3 groups according to the presence or absence of inflammation and AF culture results; 1) without inflammation and a negative AF culture (N=28); 2) with inflammation and a negative AF culture (N=26); 3) with a positive AF culture (N=35). The FIR was examined in 89 cases of PPROM who delivered singleton preterm newborns within 48 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria and mycoplasmas. AF inflammation was defined as an elevated AF MMP-8 concentration (>23 ng/mL). The intensity of the FIR was examined by the umbilical cord plasma concentrations of C-reactive protein (CRP). Patients were divided into 3 groups according to the presence or absence of inflammation and AF culture results; 1) without inflammation and a negative AF culture (N=28); 2) with inflammation and a negative AF culture (N=26); 3) with a positive AF culture (N=35). Results1) Newborns born to mothers with IAI but with a negative AF culture had a significantly lower median umbilical cord plasma concentration of CRP than those with proven AF infection (median, 43 ng/ml; range, 5-4305 ng/ml; vs median, 285 ng/ml; range, 18-4534 ng/ml; p<.05). but a significantly higher median cord plasma CRP than those without IAI and a negative AF culture (p<.005); 2) Patients with IAI but with a negative AF culture had significantly higher median AF MMP-8 and WBC count than those without IAI and a negative AF culture (p<.001). 1) Newborns born to mothers with IAI but with a negative AF culture had a significantly lower median umbilical cord plasma concentration of CRP than those with proven AF infection (median, 43 ng/ml; range, 5-4305 ng/ml; vs median, 285 ng/ml; range, 18-4534 ng/ml; p<.05). but a significantly higher median cord plasma CRP than those without IAI and a negative AF culture (p<.005); 2) Patients with IAI but with a negative AF culture had significantly higher median AF MMP-8 and WBC count than those without IAI and a negative AF culture (p<.001). ConclusionIAI in cases without documented AF infection is a risk factor for a systemic FIR. However, the magnitude of the FIR in those cases was lower than that in those with documented AF infection. These observations have implications for the implementation of strategies to detect IAI and infection as well as for the treatment of newborns. IAI in cases without documented AF infection is a risk factor for a systemic FIR. However, the magnitude of the FIR in those cases was lower than that in those with documented AF infection. These observations have implications for the implementation of strategies to detect IAI and infection as well as for the treatment of newborns.

Some investigators have proposed that Prostaglandis (PGs) are not a cause of labor, but rather increase as a consequence of labor. To address whether amniotic fluid (AF) PGs concentrations increase before the onset of labor, we conducted a cross sectional study and determined PGE2 and PGF2a, the two main PGs involved in parturition. The PG concentrations were determined in AF obtained from 167 singleton pregnant women. Patients were divided into 4 groups: 1) preterm not in labor (n = 65); 2) term not in labor (n = 68); 3) spontaneous labor at term with cervical dilatation <4 cm (n=25); 4) spontaneous labor at term with cervical dilatation >=4 cm (n = 9). AF was obtained by transabdominal amniocentesis or collected at cesarean delivery. All met the following criteria: 1) normal outcome, 2) intact membranes, 3) clear AF, 4) no significant medical, obstetric or neonatal complications. 1) AF PGs concentrations remained unchanged with advancing gestation until 36 weeks of gestation; 2) However, an abrupt increase in AF PGs was observed before the onset of labor at term (Figure 1); 3) Among cases without labor at term, AF PGF2a but not PGE2 increased with advancing gestation (Figure 2); 4) Labor and the degree of cervical dilatation were significantly associated with a higher concentration of PGF2a but not with PGE2. 1) An abrupt increase of AF PG concentrations occurs before the onset of spontaneous term labor in humans; 2) These observations suggest that PGs increase prior to the onset of labor and contradict the claim that an increase in PGs concentrations are the consequence of labor.

The purpose of this study was to determine the frequency of intra-amniotic infection, intra-amniotic inflammation (IAI) and placental inflammation in PPROM. The central issue is whether the infection/inflammation is so prevalent that expectant management may be unsafe. The presence or absence of inflammation of placenta, umbilical cord and amniotic fluid (AF) obtained within 7 days of birth was examined in 124 patients with early preterm births (GA 20-33 weeks) with PPROM. AF was cultured for aerobic and anaerobic bacterias and Mycoplasmas. In addition, AF WBC count and matrix metalloproteinase-8 (MMP-8) determinations were performed. IAI was defined as the presence of a positive AF culture or elevated AF MMP-8 concentration (>23 ng/ml). 1) The prevalence of proven AF infection, IAI, funisitis and histologic chorioamnionitis was 38%, 79%, 59% and 80%, respectively; 2) The lower gestational age at birth, the higher the frequency of proven AF infection, IAI, funisitis and histologic chorioamnionitis, and elevated AF WBC count (p<.05) for each. Preterm delivery at an early gestational age (<30 weeks) is associated with a high rate of fetal inflammation (around 75%) and a 50% frequency of proven infection. Since most of these infections are asymptomatic, a pertinent clinical question is whether expectant management of a patient with a chronically infected amniotic cavity is safe for the fetus.

ObjectiveTo compare the intensity of the inflammatory response between patients with intra-amniotic infection (IAI) with Ureaplasma urealyticum (UU) and those with an IAI with other microorganisms in preterm gestations.Study designThe intensity of amniotic fluid (AF) and maternal systemic inflammatory response was examined in 110 cases with a positive AF culture (GA≤36weeks). Patients were divided into two groups according to the microorganisms recovered from AF 1) UU (n=66); 2) other microorganisms (n=44). Cases with mixed infection with UU were excluded. The intensity of the AF inflammatory response was evaluated through the AF white blood cell (WBC) count and that of the maternal inflammatory response was by the concentration of C-reactive protein (CRP) in maternal blood obtained at the time of amniocentesis.ResultsConclusion1) Patients with IAI with UU have a higher intra-amniotic and maternal inflammatory response than those with IAI with other microorganisms. This observation challenges the traditional view that UU has low virulence; 2) We propose that chronic exposure to this microorganism may explain the apparent discrepancy between previously held beliefs and our findings. ObjectiveTo compare the intensity of the inflammatory response between patients with intra-amniotic infection (IAI) with Ureaplasma urealyticum (UU) and those with an IAI with other microorganisms in preterm gestations. To compare the intensity of the inflammatory response between patients with intra-amniotic infection (IAI) with Ureaplasma urealyticum (UU) and those with an IAI with other microorganisms in preterm gestations. Study designThe intensity of amniotic fluid (AF) and maternal systemic inflammatory response was examined in 110 cases with a positive AF culture (GA≤36weeks). Patients were divided into two groups according to the microorganisms recovered from AF 1) UU (n=66); 2) other microorganisms (n=44). Cases with mixed infection with UU were excluded. The intensity of the AF inflammatory response was evaluated through the AF white blood cell (WBC) count and that of the maternal inflammatory response was by the concentration of C-reactive protein (CRP) in maternal blood obtained at the time of amniocentesis. The intensity of amniotic fluid (AF) and maternal systemic inflammatory response was examined in 110 cases with a positive AF culture (GA≤36weeks). Patients were divided into two groups according to the microorganisms recovered from AF 1) UU (n=66); 2) other microorganisms (n=44). Cases with mixed infection with UU were excluded. The intensity of the AF inflammatory response was evaluated through the AF white blood cell (WBC) count and that of the maternal inflammatory response was by the concentration of C-reactive protein (CRP) in maternal blood obtained at the time of amniocentesis. Results Conclusion1) Patients with IAI with UU have a higher intra-amniotic and maternal inflammatory response than those with IAI with other microorganisms. This observation challenges the traditional view that UU has low virulence; 2) We propose that chronic exposure to this microorganism may explain the apparent discrepancy between previously held beliefs and our findings. 1) Patients with IAI with UU have a higher intra-amniotic and maternal inflammatory response than those with IAI with other microorganisms. This observation challenges the traditional view that UU has low virulence; 2) We propose that chronic exposure to this microorganism may explain the apparent discrepancy between previously held beliefs and our findings.