Study of Association of C-Reactive Protein with Maternal Chorioamnionitis and Early-Onset Neonatal Sepsis in Premature Rupture of Membranes Deliveries: A Diagnostic Dilemma

Abstract

Introduction: Term prelabor rupture of membranes and preterm premature rupture of membranes (PROM), both pose significant risk to the mother and the fetus. Early identification of sepsis is essential as the mother has risk of chorioamnionitis and neonate is at the risk of early-onset sepsis. Aim: To evaluate the diagnostic value of positive maternal C-reactive protein (CRP) in association with maternal clinical chorioamnionitis and early-onset neonatal sepsis (EONS) in PROM deliveries after 28 weeks of gestation. Methodology: The study was conducted at People's College of Medical Science and Research Centre, Bhopal, from June 1, 2017, to May 31, 2018. Maternal serum CRP test was correlated to the signs of maternal chorioamnionitis and signs of EONS within 72 h of life. Results: The maternal CRP test was compared to clinical signs of chorioamnionitis. Sensitivity of CRP for diagnosing maternal chorioamnionitis was 48% (95% confidence interval [CI] −35.99–61.12), specificity was 81 (95% CI 71.55%–88.98%), and odds ratio of maternal chorioamnionitis was 4.1176 (95% CI 1.99–8.51) with P < 0.0001. Sensitivity of positive maternal CRP in diagnosing EONS was 56.67% (95% CI 43.24%–69.41%), specificity was 84.78% (95% CI 75.79%–91.42%), and odds ratio of neonatal sepsis in maternal CRP positive was 7.28 (95%CI 3.39–15.64) with P < 0.0001. Conclusion: Our study suggests that in PROM deliveries, if maternal CRP test is positive, then it indicates early delivery and neonate screening for EONS.