Biomarkers of Intra-amniotic Infection in Women With Preterm Premature Ruptured Amniotic Membranes (PPROM)

Identification of Proteomic Markers of Intra-amniotic Infection (IAI) in Patients With Preterm Premature Rupture of Amniotic Membranes (PPROM)

The purpose of this study is to investigate the expression of protein biomarkers in cervical vaginal fluid in women with preterm premature rupture of membranes (PPROM)

Study Overview

• Status: Completed
• Conditions: Preterm Birth; Intra-amniotic Infection

Detailed Description

Preterm premature rupture of the membranes (PPROM) prior to 37 weeks of gestation occurs in approximately 3% of all pregnancies and is associated with one-third of all preterm births (Mercer, 2003). While there are multiple possible etiologies of PPROM, intra-amniotic infection has been implicated as a major contributor, especially at early gestational ages where fetal and neonatal adverse sequelae are frequent (Yoon, et al. 2000). Micro-organisms are recovered from the amniotic fluid obtained by trans-abdominal amniocentesis in 25-40% of women at the time of presentation with PPROM (Simhan and Canavan 2005).

Significant risks to the fetus following PPROM include both complications related to prematurity and to infection or inflammation (ACOG Practice Bulletin 2007). Complications related to prematurity include respiratory distress, intraventricular hemorrhage, and necrotizing enterocolitis. IAI, both clinically apparent and occult, is an important and potentially preventable cause of cerebral white matter injury and cerebral palsy. Ideally, an early diagnosis of IAI in the setting of PPROM is important to allow timely treatment and intervention. Amniocentesis is successful from 40 - 72% of the time with PPROM (Garite, 1982, Blackwell and Berry, 1999). Despite the accuracy for determining infection and the feasibility of amniocentesis, the vast majority of clinicians are reluctant and/or unwilling to perform this procedure in this clinical setting (Capeless and Mead, (1987). There is therefore a critical need for a noninvasive test to identify patients with IAI and PPROM. Timely identification of these sub-clinically infected patients is critical in designing rationale and efficacious treatment strategies that may reduce the fetal and neonatal sequelae associated with PPROM.

• Study Type: Observational
• Enrollment (Actual): 79

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Phoenix, Arizona, United States, 85006
      • Banner Good Samaritan Hospital
    • Tucson, Arizona, United States, 85712
      • Tucson Medical Center
  • California
    • San Jose, California, United States, 95008
      • Good Samaritan Hospital
  • Colorado
    • Denver, Colorado, United States, 80218
      • Presbyterian St. Luke's Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Women within the target gestational age range presenting to labor and delivery wards with documented rupture of amniotic membranes no greater than 24 hours duration.

Description

Inclusion Criteria:

• Subject is 18 years of age or older
• Subject has singleton gestation
• Subject has fetus with getstational age of at least 23 0/7 days and no greater than 33 6/7 days

• Subject has diagnosis of preterm premature rupture of amniotic membranes as determined by at least two of the following:

  1. Postive pooling,
  2. Presence of ferning from cervical vaginal fluid swab on an air dried slide,
  3. Postivie nitrizine pH test, or, in lieu of the criteria listed above
  4. Positive Amnisure test result
  5. Positive indigo carmine egress vaginally following instillation at amniocentesis
• Subject is enrolled and has an amniocentesis within 24 hours of membrane rupture

• Subject is a candidate for expectant management as evidenced by the following:

  1. Absence of labor (defined by absence of painful uterine contractions)
  2. No clinical signs of infection (maternal fever of 37.9 C or greater, fetal heart rate greater than 160 bpm, uterine tenderness, purulent aminorrhea)
  3. presence of non-reassuring heart tracing

• Subject is a candidate for amniocentesis as evidenced by the following:

  1. Ultrasound reveals pocket of fluid likely to result in successful amniocentesis
  2. Physician believes that the subject shoudl undergo amniocentesis as part of their routine evaluation of their current problem of PPROM to rule out infection and/or to test for lung maturity

Exclusion Criteria:

• Subject has a fetus with major fetal anomaly (life threatening or requires surgical intervention) or chromosomal aneuploidy
• Subject has pre-existing medical indication for preterm delivery (e.g., pre-eclampsia, refractory hypertension, diabetes with significant complications, active lupus)
• Subject is unable to provide informed consent

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
1; Women presenting with preterm gestation and ruptured membranes

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Expression of protein biomarkers in cervial vaginal fluid	24 hours of amniotic membrane rupture to delivery

Collaborators and Investigators

• Sponsor: ProteoGenix, Inc.
• Collaborators: Obstetrix Medical Group
• Investigators: Principal Investigator: Richard Porecco, MD, Obstetrix Medical Group

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): February 1, 2010
• Study Completion (Actual): February 1, 2010

Study Registration Dates

• First Submitted: June 13, 2008
• First Submitted That Met QC Criteria: June 18, 2008
• First Posted (Estimate): June 19, 2008

Study Record Updates

• Last Update Posted (Estimate): July 21, 2010
• Last Update Submitted That Met QC Criteria: July 19, 2010
• Last Verified: July 1, 2010

More Information

Terms related to this study

• Keywords: Pregnancy; Preterm Birth; Intra-amniotic Infection; Preterm Premature Rupture of Membranes
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pregnancy Complications; Obstetric Labor Complications; Obstetric Labor, Premature; Infections; Communicable Diseases; Premature Birth
• Other Study ID Numbers: PGX03-OBX0009