Predictive Value Of Serum Amyloid A In Premature Rupture Of Membranes Complicated With Subclinical Chorioamnionitis And Pregnancy Outcome Analysis

Objective:Predictive value of serum amyloid A in premature rupture of membranes complicated with subclinical chorioamnionitis and pregnancy outcome analysis Methods:1.According to the entry and exclusion criteria,90 inpatients with premature rupture of membranes in Shenzhen Luohu District Maternal and Child Health Hospital from September 1,2020 to September 1,2021 were selected as the experimental group.According to the pathological results of postpartum placenta,the experimental group was divided into two small subgroups(subclinical chorioamnionitis positive group and subclinical chorioamnionitis negative group)with 45 cases in each group.The pregnant women who were hospitalized in our hospital during the same period without pregnancy complications and complications were selected as the normal delivery group(control group),45 cases were selected.General clinical data including age,gestational age,number of births and BMI were collected in different groups.2.Peripheral blood 8ml was collected from patients in different groups before antibiotic use and before labor.Routine blood infection indexes were determined by flow cytometry,the levels of serum amyloid protein A(SAA)were determined by latex enhanced immunoturbidimetry,the levels of procalcitonin(PCT)were analyzed by cyclic enhanced fluorescence immunoassay,and the levels of C-reactive protein(CRP)were determined by immunoturbidimetry.3.About 60 g of placental tissue was taken from the central part of the patients in the premature breakage group,rinsed repeatedly with 0.9% sodium chloride injection,fixed with 4% neutral formaldehyde,paraffin embedding was performed 24 hours later,and the WBC and NEUT were observed by EM-30 AX high-power electron microscope.4.In addition,the fetal membranes of the patients in the prom group were taken for pathological examination,cut from the rupture of the membranes to the membranes near the placenta,and a piece about the width of 6cm was taken,rinsed repeatedly with 0.9% sodium chloride injection,rolled into a barrel to make a roll of the membranes,then fixed with 4% neutral formaldehyde,and then embedded in paraffin 24 hours later,made with EM-30 AX high-power electron microscope(Zhou Keguan Electronic Technology Co.Ltd).The number of neutrophils or lymphocytes in the visual field is larger than that of 5/HP or the number of neutrophils is greater than5/HP,which can be diagnosed as subclinical chorioamnionitis.5.The levels of maternal serum SAA,PCT,CRP and WBC were compared among different groups.The incidence of intrauterine infection was compared between different groups.SPSSStatistics22.0 software was used to analyze the data.Mean ± standard deviation was used for measurement data,and independent sample t test was used for comparison between the two groups.Count data were described by composition ratio or percentage and compared between groups by chi-square test.The difference was statistically significant(P < 0.05).Results:1.There was no significant difference between the experimental group and the control group in general clinical data,including age,birth time,gestational age and body mass index(BMI).2.The levels of WBC,SAA,PCT and CRP in the test group were(15.53±4.49)×109/L,18.83±14.97 mg/L,0.55±0.27 ng/m L,12.14±7.49 mg/L,respectively,while the average values of WBC,SAA,PCT and CRP in the control group were(10.04±1.79)×109/L,7.61±1.59 mg/L,0.27±0.14 ng/m L,5.88±1.69 mg/L,respectively(P < 0.05).The results of comparison between the two groups showed that the serum levels of WBC,SAA,PCT and CRP were significantly different between the pregnant women with premature rupture of membranes and the pregnant women with normal delivery without pregnancy complications or complications.3.The average values of WBC,SAA,PCT and CRP in subclinical chorioamnionitis positive group were(18.77±4.01)×109/L,29.06±15.35mg/L 、0.78±0.94ng/m L,17.08±7.61mg/L,respectively.The average values of WBC,SAA,PCT and CRP in subclinical chorioamnionitis negative group were(12.29±1.78)×109/L,8.61±2.02 mg/L,0.31±0.16 ng/m L,7.20±2.40 mg/L,respectively.There were significant differences in serum levels of WBC,SAA,PCT and CRP between the two groups.The average values of WBC,SAA,PCT and CRP in the control group were(10.04±1.79)×109/L,7.61±1.59 mg/L,0.27±0.14 ng/m L,5.88±1.69 mg/L respectively.By comparing the serum average levels of WBC,SAA,PCT and CRP,between the subclinical chorioamnionitis positive group and the control group,there were significant differences in serum WBC,PCT,CRP and SAA between the two groups.The results showed that the serum level of SAA in pregnant women with premature rupture of membranes combined with subclinical chorionic amnitis was significantly increased,and the serum level of SAA could predict whether the pregnant women with premature rupture of membranes combined with subclinical chorionic amnitis.4.Draw ROC curve,SAA predicted subclinical chorioamnionitis in pregnant women,the area under the curve AUC was 0.883,the sensitivity was 86.1%,the specificity was 84.2%,the accuracy was 85.4%,and the Yoden index was70.3%.WBC predicts that the area under the curve AUC is 0.649,the sensitivity is66.3%,the specificity is 56.7%,the accuracy is 71.3%,and the Jordan index is23.0%.The area under the PCT prediction curve AUC is 0.610,the sensitivity is71.4%,the specificity is 48.3%,the accuracy is 66.1%,and the Jordan index is19.7%.CRP predicted that the area under the curve AUC was 0.806,the sensitivity was 73.9%,the specificity was 81.8%,the accuracy was 79.6%,and the Jordan index was 55.7%.The sensitivity,specificity and accuracy of SAA prediction were the highest,and the prediction efficiency was the best.5.Among the 90 cases in the experimental group,the mean WBC,SAA,PCT and CRP of the pregnant women in the intrauterine infection pneumonia group were respectively27.10±5.55×109/L,59.13±17.33mg/L,0.86±0.51ng/m L,25.63±18.71mg/L.The WBC,SAA,PCT and CRP of pregnant women without intrauterine infectious pneumonia were respectively(14.70±3.07)×109/L,15.96±9.83mg/L,0.52±0.26ng/m L,11.18±5.00mg/L.There were significant differences in serum levels of WBC,SAA,PCT and CRP between the two groups.The results showed that the increased SAA serum level in pregnant women may have a certain correlation with intrauterine infection of newborns,which can be discussed in the follow-up study.6.The postpartum blood loss of HCA-negative women was(196±71)m L,cesarean section accounted for 15.56%,the proportion of fetal distress was11.11%,the proportion of puerperal infection was 0%.The postpartum blood loss of HCA-positive parturient was(395±104)m L,cesarean section accounted for26.67%,the proportion of fetal distress was 31.11%,the proportion of puerperal infection was 22.22%.HCA-positive pregnant women have more blood loss,higher cesarean section rate,higher fetal distress rate and higher puerperal infection rate than HCA-negative pregnant women.Therefore,the pregnancy outcome of pregnant women with negative subclinical chorioamnitis is better than that of pregnant women with positive clinical chorioamnitis.Conclusion:1.The expression of SAA in pregnant women with premature rupture of membranes was significantly higher than that in pregnant women with normal delivery2.The serum level of SAA in pregnant women with premature rupture of membranes complicated with subclinical chorioamnionitis is higher than that in normal delivery group.SAA can be used to predict subclinical chorioamnionitis.3.The level of SAA in the group with intrauterine infection was significantly higher than that in the group without intrauterine infection.