Histological chorioamnionitis could be predicted with high accuracy in preterm labor with intact membranes before delivery

Abstract

Objective: Histological chorioamnionitis was associated with adverse outcomes. The objective of this study was to develop a prediction model for histological chorioamnionitis in preterm labor with intact membranes. Materials and Methods: Data were obtained from 307 women with singleton preterm labor (gestational age 28-33+6 weeks) of the intact membranes between October 2011 and July 2014 in the Ningbo Women and Children's Hospital, Ningbo, China. Histological chorioamnionitis (HC) prediction model was developed with maternal independent risk factors before delivery. Results: Multivariable Logistic regression analysis showed that serum C-reactive protein (CRP) (OR=1.175, p = 0.0015, 95% confidence interval (CI) 1.064~1.297), and procalcitonin (PCT) (OR=9.736, p = 0.0117, 95% CI 1.658~57.166) were independent risk factors of HC. When PCT ≥ 0.05 ng/ml and CRP > 7.3 mg/L or PCT < 0.05 ng/ml and CRP > 21.4 mg/L, HC could be detected. HC was predicted with 91.1% accuracy, yielding an area under receiver operating characteristic (ROC) curve of 0.938 (95% CI 0.857~0.996), a positive predictive value of 84.6% (95% CI 65.1~95.6%), and a negative predictive value of 96.7% (95% CI 82.8~99.9%). Conclusion: Combined with CRP and PCT, HC could be predicted with high accuracy in preterm labor with intact membranes before delivery. Further studies should evaluate the value of this model to guide early treatment.