Journal Mobile Options
Table of Contents
Vol. 60, No. 2, 2005
Issue release date: August 2005

Increased Level of Granulocyte Elastase in Cervical Secretion Is an Independent Predictive Factor for Preterm Delivery

Nakai A. · Taniuchi Y. · Miyake H. · Nakai M. · Yokota A. · Takeshita T.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor. Methods: One hundred and sixty-one women with preterm labor at 22–28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography. Results: Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3–6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8–4.6) and 1.5 (95% CI 0.6–5.0), respectively. Conclusion: The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Harbert GMJ: Efforts to reduce low birth weight and preterm births: A statewide analysis. Am J Obstet Gynecol 1994;171:329–340.
  2. Mercer BM, Goldenberg RL, Das A, Moawad AH, Iams JD, Meis PJ, et al: The preterm prediction study: A clinical risk assessment system. Am J Obstet Gynecol 1996;174:1885–1893.
  3. Ludmir J, Sehdev H: Anatomy and physiology of the uterine cervix. Clin Obstet Gynecol 2000;43:433–439.
  4. Gramse M, Bingenheimer C, Schmidt W: Degradation products of fibrinogen by elastase-like neutral protease from human granulocytes. J Clin Invest 1978;61:1027–1033.
  5. Wojtecka-Lukasik E, Kaczanowska J, Tomczak Z: Effects of neutral protease from human leukocytes on plasma fibronectin. Thromb Res 1984;33:471–476.
  6. Kanayama N, Terao T: The relationship between granulocyte elastase-like activity of cervical mucus and cervical maturation. Acta Obstet Gynecol Scand 1991;70:29–34.
  7. Yamada T, Minakami H, Matsubara S, Yatsda T, Sato I: Changes in polymorphonuclear leukocytes in the vagina of patients with preterm labor. Gynecol Obstet Invest 1998;45:32–34.
  8. Gibbs RS, Romero R, Hillier SL, Eschenbach DA, Sweet RL: A review of premature birth and subclinical infection. Am J Obstet Gynecol 1992;166:1515–1528.
  9. Arinami Y, Hasegawa I, Takakuwa K, Tanaka K: Prediction of preterm delivery by combined use of simple clinical tests. J Matern Fetal Med 1999;8:70–73.
  10. Nugent RP, Krohn MA, Hillier SL: Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991;29:297–301.
  11. Iams JD, Goldenberg RT, Meis PJ, Mercer BM, Maoawad A, Das A, et al: The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996;334:567–572.
  12. Iams JD: Prediction and early detection of preterm labor. Obstet Gynecol 2003;101:402–412.
  13. Murakawa H, Utumi T, Hasegawa I, Tanaka K, Fujimori R: Evaluation of threatened preterm delivery by transvaginal ultrasonographic measurement of cervical length. Obstet Gynecol 1993;82:829–832.
  14. Iams JD, Paraskos J, Landon MB, Teteris JN, Johnson F: Cervical sonography in preterm labor. Obstet Gynecol 1994;84:40–46.
  15. Honest H, Bachmann LM, Knox EM, Gupta JK, Kleijnen J, Khan KS: The accuracy of various tests for bacterial vaginosis in predicting preterm birth: A systematic review. Br J Obstet Gynaecol 2004;111:409–422.
  16. Morales WJ, Schorr S, Albritton J: Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: A placebo-controlled, double-blind study. Am J Obstet Gynecol 1994;171:345–347.
  17. Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL: Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;333:1732–1736.
  18. Vermeulen GM, Bruinse HW: Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: A randomized placebo-controlled double-blind trial. Br J Obstet Gynaecol 1999;106:652–657.
  19. Woessner JF: Uterus, cervix and ovary; in Weiss JB, Jayson MIV (eds): Collagen in Health and Disease. Edinburgh, Churchill-Livingstone, 1982, pp 506–515.
  20. Huszar G, Naftolin F: The myometrium and uterine cervix in normal and preterm labor. N Engl J Med 1984;311:571–581.
  21. Von Maillot K, Stuhlsatz HW, Mohanaradhakrishnan V: Changes in the glycosaminoglycans distribution pattern in the human uterine cervix during pregnancy and labor. Am J Obstet Gynecol 1979;135:503–506.
  22. Rivero-Marcotegui A, Larranaga-Azcarate C, Ceres-Ruiz R, Garcia-Merlo S: Polymorphonuclear elastase and interleukin-6 in amniotic fluid in preterm labor. Clini Chem 1997;43:857–859.
  23. Goldenberg RL, Hauth JC, Andrews WW: Intrauterine infection and preterm delivery. N Engl J Med 2000;342:1500–1507.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50