An evaluation into the use of Procalcitonin levels as a biomarker of bacterial sepsis to aid the management of Intrapartum Pyrexia and Chorioamnionitis: a prospective observational cohort study

Objective: Procalcitonin (PCT) is an established biomarker for bacterial sepsis in the non-pregnant population. We aimed to evaluate PCT levels in women and their neonates managed with suspected intrapartum bacterial sepsis, to determine if PCT could be utilised to optimise diagnosis and management. Design: Prospective observational cohort study. Setting: University Hospitals of Bristol and Weston NHS Foundation trust. Population: 117 women and their neonates managed for suspected intrapartum sepsis from June-October 2020. Methods: PCT levels were measured in addition to routine biomarkers white cell count and c-reactive protein, in women and their neonates during initial septic screen and follow up blood samples. Placentas underwent detailed histopathology. Main Outcome Measures: Maternal and neonatal parameters were used to categorise cases into: ‘high-suspicion bacterial sepsis (BS),’ ‘equivocal BS’ and ‘low-suspicion BS.’ Kruskal-Wallis test was performed comparing categories with biomarker values and placental histology scores. Results: PCT was raised in 6 women in the initial septic screen sample, compared to 100 with a raised CRP. There was a significant difference in maternal postnatal PCT results between ‘high-suspicion BS’ and ‘low-suspicion BS’ categories. 71.2% of placentas showed varying degrees of chorioamnionitis. Conclusions: In our cohort of women, 94.6% had normal PCT levels whilst in labour at the time of the septic screen, consistent with the low number of confirmed bacteraemia. This provides a basis that PCT may complement clinical judgement and interpretation of already utilised prognostic and diagnostic tests, in order to improve patient care in the management of intrapartum sepsis.