预测早产胎膜早破孕妇组织学绒毛膜羊膜炎和真菌炎的诊断测试:系统综述。

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Valeria Lanzarone, Adam Polkinghorne, Guy Eslick, James Branley
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引用次数: 0

摘要

背景:羊膜腔感染是早产胎膜早破(PPROM)的重要诱因和/或后果。对感染的预测具有挑战性,从而限制了产前干预的指导。感染通常会引发宿主炎症反应,有报道称在早产儿胎膜早破(PPROM)和羊膜腔内感染的情况下,母体或胎儿炎症反应的非侵入性间接标记物。目的:本研究将 PPROM 妇女的炎症反应标记物与组织学绒毛膜羊膜炎(HCA)或真菌炎(FUS)的结果标准进行了比较:方法:对报告妊娠 20 周后 PPROM 孕妇经证实的 HCA 或 FUS 诊断测试敏感性和特异性的研究进行了搜索。结果:除超声波检测胎儿畸形外,其他诊断试验的敏感性、特异性、阳性预测值、阴性预测值、诊断几率和95%置信区间均有所差异:除超声波检测胎儿胸腺内陷外,几乎所有分析指标检测的灵敏度都相对较低。母体白细胞计数、白细胞介素-6(IL-6)和房颤 IL-6 的特异性可信。心房颤动标志物的检测虽然比血清标志物更一致,但并没有明显提高诊断准确性:结论:目前显然缺乏证据证明任何单项诊断测试可帮助检测患有先兆流产(PPROM)的妇女是否患有 HCA 或 FUS。将几种标记物结合到一个预测模型中以提高诊断率可能值得研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic tests for the prediction of histological chorioamnionitis and funisitis in pregnant women with preterm premature rupture of membranes: A systematic review.

Background: Infection of the amniotic cavity is an important driver and/or consequence of preterm prelabour rupture of membranes (PPROM). Prediction of infection is challenging, limiting guidance for interventions during the antenatal period. Infection typically triggers a host inflammatory response, and non-invasive indirect markers of the maternal or fetal inflammatory response have been reported in the context of PPROM and intra-amniotic infection. Some of these markers have also been tested in amniotic fluid (AF) samples.

Aims: This study compared markers of the inflammatory response in women with PPROM against the outcome standard of histological chorioamnionitis (HCA) or funisitis (FUS).

Methods: Searches were conducted for studies reporting diagnostic test sensitivity and specificity for proven HCA or FUS in pregnant women with PPROM after 20 weeks' gestation. Weighted mean pooled sensitivity (Se), specificity (Sp), positive predictive value, negative predictive value, diagnostic odds ratio and 95% confidence intervals were calculated for each of the selected diagnostic tests.

Results: Except ultrasonographic detection of fetal thymic involution, almost all index tests analysed showed relatively low sensitivity. Maternal white cell count, interleukin-6 (IL-6) and AF IL-6 had credible specificity. Testing of AF markers, while more consistent than serum markers, showed no clear diagnostic accuracy improvement.

Conclusions: There is a clear lack of evidence for the reliability of any individual diagnostic test to assist in the detection of HCA or FUS in women with PPROM. Combining several markers into a predictive model for improved diagnosis may be worth investigating.

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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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