Ultrasound diagnosis of fetal inflammatory response syndrome in women with preterm premature rupture of membrane


Authors: R. Špaček 1;  I. Musilová 2;  K. Magdová 1;  O. Šimetka 1;  M. Kacerovský 2
Authors‘ workplace: Gynekologicko-porodnická klinika FN, Ostrava přednosta doc. MUDr. O. Šimetka, Ph. D., MBA 1;  Porodnická a gynekologická klinika FN, Hradec Králové přednosta doc. MUDr. J. Špaček, Ph. D., IFEPAG 2
Published in: Čes. Gynek.2017, 82, č. 2 s. 145-151

Overview

Objective:
The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response.

Design:
Review.

Settings:
Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava.

Methods:
Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome.

Conclusion:
Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.

Keywords:
interleukin-6, adrenal glands, amniotic fluid, heart, kidney, preterm delivery, spleen, thymus


Sources

1. The prevention of perinatal mortality and morbidity. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser, 1970, 457, p. 1–60.

2. Aina-Mumuney, AJ., Althaus, JE., Henderson, JL., et al. Intrapartum electronic fetal monitoring and the identification of systemic fetal inflammation. J Reprod Med, 2007, 52, 9,p. 762–768.

3. Bone, RC., Balk, RA., Cerra, FB., et al. American-College of Chest Physicians Society of Critical Care Medicine Consensus Conference – Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. Crit Care Med, 1992, 20, 6, p. 864–874.

4. Bredeson, S., Papaconstantinou, J., Deford, JH., et al. HMGB1 promotes a p38MAPK associated non-infectious inflammatory response pathway in human fetal membranes. PLoS One, 2014, 9, 12, p. e113799.

5. Buhimschi, CS., Buhimschi, IA., Abdel-Razeq, S., et al. Proteomic biomarkers of intra-amniotic inflammation: relationship with funisitis and early-onset sepsis in the premature neonate. Pediatr Res, 2007, 61, 3, p. 318–324.

6. Buhimschi, CS., Turan, OM., Funai, EF., et al. Fetal adrenal gland volume and cortisol/dehydroepiandrosterone sulfate ratio in inflammation-associated preterm birth. Obstet Gynecol, 2008, 111, 3, p. 715–722.

7. Cetin, O., Dokurel Cetin, I., Uludag, S., et al. Serial ultrasonographic examination of the fetal thymus in the prediction of early neonatal sepsis in preterm premature rupture of membranes. Gynecol Obstet Invest, 2014, 78, 3, p. 201–207.

8. Cobo, T., Kacerovsky, M., Andrys, C., et al. Umbilical cord blood IL-6 as predictor of early-onset neonatal sepsis in women with preterm prelabour rupture of membranes. PLoS One, 2013, 8, 7, p. e69341.

9. Cromi, A., Ghezzi, F., Raffaelli, R., et al. Ultrasonographic measurement of thymus size in IUGR fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obst Gyn, 2009, 33, 4, p. 421–426.

10. Di Naro, E., Cromi, A., Ghezzi, F., et al. Myocardial dysfunction in fetuses exposed to intraamniotic infection: new insights from tissue Doppler and strain imaging. Am J Obstet Gynecol, 2010, 203, 5.

11. Di Naro, E., Cromi, A., Ghezzi, F., et al. Fetal thymic involution: A sonographic marker of the fetal inflammatory response syndrome. Am J Obstet Gynecol, 2006, 194, 1, p. 153–159.

12. El-Haieg, DO., Zidan, AA., El-Nemr, MM. The relationship between sonographic fetal thymus size and the components of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes. BJOG, 2008, 115, 7, p. 836–841.

13. Felker, RE., Cartier, MS., Emerson, DS., Brown, DL. Ultrasound of the fetal thymus. J Ultras Med, 1989, 8, 12, p. 669–673.

14. Gauthier, DW., Meyer, WJ., Bieniarz, A. Biophysical profile as a predictor of amniotic fluid culture results. Obstet Gynecol, 1992, 80, 1, p. 102–105.

15. Gomez, R., Romero, R., Ghezzi, F., et al. The fetal inflammatory response syndrome. Am J Obstet Gynecol, 1998, 179, 1, p. 194–202.

16. Gomez, RG., Romero, R., Yoon, BW., et al. Two thirds of human fetuses with microbial invasion of the amniotic cavity have a detectable systemic cytokine response before birth. Am J Obstet Gynecol, 1997, 14, p. 176.

17. Gordon, J., Manley, NR. Mechanisms of thymus organogenesis and morphogenesis. Development, 2011, 138, 18, p. 3865–3878.

18. Hofer, N., Kothari, R., Morris, N., et al. The fetal inflammatory response syndrome is a risk factor for morbidity in preterm neonates. Am J Obstet Gynecol, 2013, 209, 6, p. 542, e541–542 e511.

19. Hoffman, MK., Turan, OM., Parker, CB., et al. Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth. Obstet Gynecol, 2016, 127, 4, p. 726–734.

20. Chaoui, R., Heling, KS., Lopez, AS., et al. The thymic-thoracic ratio in fetal heart defects: a simple way to identify fetuses at high risk for microdeletion 22q11. Ultrasound Obstet Gynek, 2011, 37, 4, p. 397–403.

21. Ibrahim, MI., Sherif, A., El-Kady, M., et al. Can three-dimensional ultrasound measurement of fetal adrenal gland enlargement predict preterm birth? Arch Gynecol Obstet, 2015, 292, 3, p. 569–578.

22. Jondal, M., Pazirandeh, A., Okret, S. Different roles for glucocorticoids in thymocyte homeostasis? Trends Immunol, 2004, 25, 11, p. 595–600.

23. Kacerovsky, M., Cobo, T., Andrys, C., et al. The fetal inflammatory response in subgroups of women with preterm prelabor rupture of the membranes. J Matern Fetal Neona, 2013, 26, 8, p. 795–801.

24. Kacerovsky, M., Musilova, I., Andrys, C., et al. Oligohydramnios in women with preterm prelabor rupture of membranes and adverse pregnancy and neonatal outcomes. PLoS One, 2014, 9, 8, p. e105882.

25. Kacerovsky, M., Musilova, I., Khatibi, A., et al. Intraamniotic inflammatory response to bacteria: analysis of multiple amniotic fluid proteins in women with preterm prelabor rupture of membranes. J Matern Fetal Neona, 2012, 25, 10, p. 2014–2019.

26. Karl, K., Heling, KS., Sarut Lopez, A., et al. Thymic-thoracic ratio in fetuses with trisomy 21, 18 or 13. Ultrasound Obstet Gynecol, 2012, 40, 4, p. 412–417.

27. Langlois, D., Li, JY., Saez, JM. Development and function of the human fetal adrenal cortex. J Pediatr Endocrinol Metab, 2002, 15, Suppl. 5, p. 1311–1322.

28. Lee, J., Romero, R., Lee, KA., et al. Meconium aspiration syndrome: a role for fetal systemic inflammation. Am J Obstet Gynecol, 2016, 214, 3, p. 366, e361–369.

29. Lee, SD., Kim, MR., Hwang, PG., et al. Chorionic plate vessels as an origin of amniotic fluid neutrophils. Pathol Int, 2004, 54, 7, p. 516–522.

30. Lee, SE., Romero, R., Lee, SM., Yoon, BH. Amniotic fluid volume in intra-amniotic inflammation with and without culture-proven amniotic fluid infection in preterm premature rupture of membranes. J Perinat Med, 2010, 38, 1, p. 39–44.

31. Letti Muller, AL., Barrios Pde, M., Kliemann, LM., et al. Tei index to assess fetal cardiac performance in fetuses at risk for fetal inflammatory response syndrome. Ultrasound Obstet Gynecol, 2010, 36, 1, p. 26–31.

32. Levy, MM., Fink, MP., Marshall, JC., et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intens Care Med, 2003, 29, 4, p. 530–538.

33. Li, L., Bahtiyar, MO., Buhimschi, CS., et al. Assessment of the fetal thymus by two- and three-dimensional ultrasound during normal human gestation and in fetuses with congenital heart defects. Ultrasound Obstet Gynecol, 2011, 37, 4, p. 404–409.

34. Miralles, R., Hodge, R., Kotecha, S. Fetal cortisol response to intrauterine microbial colonisation identified by the polymerase chain reaction and fetal inflammation. Arch Dis Child Fetal Neonatal Ed, 2008, 93, 1, p. F51–54.

35. Mohamed, N., Eviston, DP., Quinton, AE., et al. Smaller fetal thymuses in pre-eclampsia: a prospective cross-sectional study. Ultrasound Obstet Gynecol, 2011, 37, 4, p. 410–415.

36. Moutquin, JM. Classification and heterogeneity of preterm birth. BJOG, 2003, 110, Suppl. 20, p. 30–33.

37. Murtha, AP., Menon, R. Regulation of fetal membrane inflammation: a critical step in reducing adverse pregnancy outcome. Am J Obstet Gynecol, 2015, 213, 4, p. 447–448.

38. Musilova, I., Andrys, C., Drahosova, M., et al. Intraamniotic inflammation and umbilical cord blood interleukin-6 concentrations in pregnancies complicated by preterm prelabor rupture of membranes. J Matern Fetal Neona, 2016, p. 1–11.

39. Musilova, I., Hornychova, H., Kostal, M., et al. Ultrasound measurement of the transverse diameter of the fetal thymus in pregnancies complicated by the preterm prelabor rupture of membranes. J Clin Ultrasound, 2013, 41, 5, p. 283–289.

40. Musilova, I., Kacerovsky, M., Andrys, C., et al. The fetal splenic vein flow pattern and fetal inflammatory response in the preterm prelabor rupture of membranes. J Matern Fetal Neona, 2014, 27, 8, p. 770–774.

41. Musilova, I., Kacerovsky, M., Hornychova, H., et al. Pulsation of the fetal splenic vein – a potential ultrasound marker of histological chorioamnionitis and funisitis in women with preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand, 2012, 91, 9, p. 1119–1123.

42. Musilova, I., Kutova, R., Pliskova, L., et al. Intraamniotic inflammation in women with preterm prelabor rupture of membranes. PLoS One, 2015, 10, 7, p. e0133929.

43. Naeye, RL., Harcke, HT., Jr., Blanc, WA. Adrenal gland structure and the development of hyaline membrane disease. Pediatrics, 1971, 47, 4, p. 650–657.

44. Newton, ER. Preterm labor, preterm premature rupture of membranes, and chorioamnionitis. Clin Perinatol, 2005, 32, 3, p. 571–600.

45. Pacora, P., Chaiworapongsa, T., Maymon, E., et al. Funisitis and chorionic vasculitis: the histological counterpart of the fetal inflammatory response syndrome. J Matern Fetal Neona, 2002, 11, 1, p. 18–25.

46. Park, JS., Yoon, BH., Romero, R., et al. The relationship between oligohydramnios and the onset of preterm labor in preterm premature rupture of membranes. Am J Obstet Gynecol, 2001, 184, 3, p. 459–462.

47. Rodriguez-Trujillo, A., Cobo, T., Vives, I., et al. Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes. Acta Obstet Gynecol Scand, 2016, 95, 8, p. 926–933.

48. Romero, R., Espinoza, J., Goncalves, LF., et al. Fetal cardiac dysfunction in preterm premature rupture of membranes. J Matern Fetal Neona, 2004, 16, 3, p. 146–157.

49. Romero, R., Espinoza, J., Kusanovic, JP., et al. The preterm parturition syndrome. Bjog, 2006, 113, Suppl.3, p. 17–42.

50. Romero, R., Gomez, R., Ghezzi, F., et al. A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition. Am J Obstet Gynecol, 1998, 179, 1, p. 186–193.

51. Sciaky-Tamir, Y., Hershkovitz, R., Mazor, M., et al. The use of imaging technology in the assessment of the fetal inflammatory response syndrome-imaging of the fetal thymus. Prenatal Diag, 2015, 35, 5, p. 413–419.

52. Turan, OM., Turan, S., Buhimschi, IA., et al. Comparative analysis of 2-D versus 3-D ultrasound estimation of the fetal adrenal gland volume and prediction of preterm birth. Am J Perinatol, 2012, 29, 9, p. 673–680.

53. Turan, OM., Turan, S., Funai, EF., et al. Fetal adrenal gland volume: a novel method to identify women at risk for impending preterm birth. Obstet Gynecol, 2007, 109, 4, p. 855–862.

54. Vaisbuch, E., Romero, R., Gomez, R., et al. An elevated fetal interleukin-6 concentration can be observed in fetuses with anemia due to Rh alloimmunization: implications for the understanding of the fetal inflammatory response syndrome. J Matern Fetal Neona, 2011, 24, 3, p. 391–396.

55. Vermillion, ST., Kooba, AM., Soper, DE. Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection. Am J Obstet Gynecol, 2000, 183, 2, p. 271–276.

56. Vintzileos, AM., Knuppel, RA. Fetal biophysical assessment in premature rupture of the membranes. Clin Obstet Gynecol, 1995, 38, 1, p. 45–58.

57. Weiss, M., Moldawer, LL., Schneider, EM. Granulocyte colony-stimulating factor to prevent the progression of systemic nonresponsiveness in systemic inflammatory response syndrome and sepsis. Blood, 1999, 93, 2, p. 425–439.

58. Yinon, Y., Zalel, Y., Weisz, B., et al. Fetal thymus size as a predictor of chorioamnionitis in women with preterm premature rupture of membranes. Ultrasound Obstet Gynecol, 2007, 29, 6, p. 639–643.

59. Yoon, BH., Kim, YA., Romero, R., et al. Association of oligohydramnios in women with preterm premature rupture of membranes with an inflammatory response in fetal, amniotic, and maternal compartments. Am J Obstet Gynecol, 1999, 181, 4, p. 784–788.

60. Zalel, Y., Gamzu, R., Mashiach, S., Achiron, R. The development of the fetal thymus: an in utero sonographic evaluation. Prenatal Diag, 2002, 22, 2, p. 114–117.

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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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