Amniotic Fluid Interleukin‐6 Determinations Are of Diagnostic and Prognostic Value in Preterm Labor

Abstract

PROBLEM: The purpose of this study was to determine if amniotic fluid concentrations of the interleukin‐6 (IL‐6) are of value in diagnosis of microbial invasion of the amniotic cavity and in the prediction of failure of tocolysis, preterm delivery and perinatal morbidity and mortality. METHOD: Amniotic fluid was obtained by transabdominal amniocentesis from 146 consecutive patients admitted with the diagnosis of preterm labor and intact membranes. Fluid was cultured for aerobic and anaerobic bacteria as well as for mycoplasmas. Amniotic fluid IL‐6 levels were measured using a monoclonal antibody‐based enzyme‐linked immunosorbent assay with a sensitivity of 0.03 ng/ml. Logistic regression and Cox's proportional hazards model were used to examine the effect of several variables on dichotomous outcomes or interval to delivery. RESULTS: Patients with a positive amniotic fluid culture had a significantly higher amniotic fluid IL‐6 concentrations than patients with a negative culture (median 91.2 ng/ml, range 0.9 to 437 ng/ml versus median 0.4 ng/ml, range P<.0001). An amniotic fluid IL‐6 concentration of greater than or equal to 11.3 ng/ml had a sensitivity of 93.3% (14 of 15) and a specificity of 91.6% (120 of 131). All patients with an amniotic fluid IL‐6 concentration above 11.3 ng/ml and a negative amniotic fluid culture (N = 11) delivered preterm and all placenta available for examination (N = 7) had histologic evidence of chorioamnionitis. Amniotic fluid concentrations of IL‐6 were an independent predictor of preterm delivery, amniocentesis‐to‐delivery interval and neonatal morbidity and mortality. Moreover, IL‐6 concentrations added significant information to the prediction of these outcomes to that provided only by clinical information such as cervical dilatation, gestational age at admission or at delivery. CONCLUSION: IL‐6 is a sensitive and rapid test for the detection of microbial invasion of the amniotic cavity and for identifying women at risk for spontaneous preterm delivery and neonates at risk for morbidity and mortality.