Objective. To identify prognostic markers of intrauterine infection (IUI) of the fetus and newborn in maternal serum, amniotic fluid, and umbilical cord serum in case of preterm birth. Patients and methods. We examined 93 pregnant women who had preterm birth (PB) from 24 to 33 weeks of gestation. Thirtyfive women delivered babies without any signs of IUI, while 30 women had newborns with mild IUI (conjunctivitis, lymphadenitis, pyoderma) and 28 women had newborns with severe IUI (early neonatal sepsis, advanced herpesvirus infection, chlamydiosis, candidiasis, pneumonia, and meningitis). We measured the levels of alpha 2-macroglobulin (α2-MG) in maternal serum (MS), umbilical cord serum (UCS) using rocket immunoelectrophoresis and in amniotic fluid (AF) using enzyme-linked immunosorbent assay (ELISA). The level of lactoferrin (LF) was assessed using ELISA. MS and UCS levels of albumin (ALB) were measured using biochemical methods, while AF level ALB was evaluated using rocket immunoelectrophoresis. Statistical analysis was performed using logistic regression. Results. We found no association between the concentration of LF in all biological fluids and the condition of newborns. Levels of ALB in MS and UCS also demonstrated no correlation with the condition of newborns. AF ALB in women who delivered babies with IUI (any grade of severity) was significantly higher than that in women who delivered babies without IUI. Women who delivered babies with severe IUI demonstrated the lowest concentration of α2-MG in their serum, whereas women who delivered babies with mild IUI had the highest α2-MG concentration. The AF α2-MG level was 10 to 20 times higher in women who had babies with IUI (any grade of severity) compared to those who had babies without IUI. Conclusion. Low α2-MG level in MS (<2.2 g/L) along with elevated α2-MG level in AF (≥6.0 mg/L) in 86–89% of PB cases indicated generalized fetal IUI and required urgent delivery without prolongation of pregnancy. Key words: albumin, alpha-2-macroglobulin, intrauterine infection, lactoferrin. premature birth
The significance of amniotic fluid immunological analysis for the prediction of intrauterine infection
