Clinical significance of histologic chorioamnionitis with a negative amniotic fluid culture in patients with preterm labor and premature membrane rupture

<div><p>Objective</p><p>To evaluate the effect of histological chorioamnionitis (HCA) with a negative amniotic fluid (AF) culture on adverse pregnancy and neonatal outcomes and inflammatory status in the AF compartment in women with preterm labor or preterm premature rupture of membranes (PPROM).</p><p>Methods</p><p>This is a retrospective cohort study of 153 women diagnosed as having a preterm labor or PPROM (20–34 weeks) who delivered singleton gestations within 48 hours of amniocentesis. AF obtained through amniocentesis was cultured, and interleukin (IL)-6, IL-8, and metalloproteinase-9 (MMP-9) levels were determined. The placentas were examined histologically.</p><p>Results</p><p>The prevalence of HCA with negative AF culture was 23.5% (36/153). The women with HCA but with a negative AF culture (group 2) and those with a positive AF culture (group 3) had a significantly lower mean gestational age at amniocentesis and delivery than those with a negative AF culture and without HCA (group 1). Women in group 3 had the highest levels of AF IL-6, IL-8, and MMP-9, followed by those in group 2, and those in group 1. Composite neonatal morbidity was significantly higher in groups 2 and 3 than in group 1, but this was no longer significant after adjusting for confounders caused mainly by the impact of gestational age.</p><p>Discussion</p><p>In the women who delivered preterm neonates, HCA with a negative AF culture was associated with increased risks of preterm birth, intense intra-amniotic inflammatory response, and prematurity-associated composite neonatal morbidity, and its risks are similar to the risk posed by positive AF culture.</p></div

Amniotic Fluid (AF) Interleukin (IL)-6, IL-8, and Metalloproteinase-9 (MMP-9) levels of the study population according to the results of the placental histological examination and AF culture.

<p>AF IL-6, IL-8, and MMP-9 levels were lowest in women with a negative AF culture without histologic chorioamnionitis (HCA) (group 1), followed by those with HCA but a negative AF culture (group 2), and highest in those with a positive AF culture (group 3) (AF IL-6: group 1, median, 0.509 ng/mL [range, 0.004–11.825 ng/mL] vs. group 2, median, 2.842 ng/mL [range, 0.047–59.934 ng/mL] vs. group 3, median, 17.839 ng/mL [range, 0.009–104.121 ng/mL]; AF IL-8: group 1, median, 0.318 ng/mL [range, 0.012–11.492 ng/mL] vs. group 2, median, 1.348 ng/mL [range, 0–52.335 ng/mL] vs. group 3, median, 21.253 ng/mL [range, 0.046–113.969 ng/mL]; AF MMP-9: group 1, median, 0.593 ng/mL [range, 0–87.920 ng/mL] vs. group 2, median, 1.572 ng/mL [range, 0–2267.941 ng/mL] vs. group 3, median, 99.232 ng/mL [range, 0–2303.970 ng/mL]; each <i>P</i>-value is shown on the graph).</p

Neonatal outcome of the study population according to the results of the placental histological examination and Amniotic Fluid (AF) culture^a

<p>Neonatal outcome of the study population according to the results of the placental histological examination and Amniotic Fluid (AF) culture<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0173312#t003fn003" target="_blank">^a</a></p

Demographics and intrapartum characteristics.

<p>ROM: rupture of membranes, BMI: body mass index.</p>†<p>Values are given as the mean ± standard deviation.</p>‡<p>Duration of 1^st stage of labor was defined as the duration of cervical dilatation from 4 cm to 10 cm; duration of 2nd stage was defined as duration between full cervical dilatation and fetal delivery; total duration of labor was defined as the sum of duration of 1^st and 2^nd stages of labor.</p

Relationship of various independent variables with the risk of cesarean section analyzed by multiple logistic regression analysis with backward elimination.

<p>ROM: rupture of membranes, BMI: body mass index, NS: not significant.</p

Pregnancy outcomes.

<p>FTP: failure to progress.</p>†<p>Values are given as the mean ± standard deviation.</p>*<p>Adjusted for maternal age, presence of hypertensive disease in pregnancy, use of intravenous oxytocin or regional analgesia (logistic regression analysis).</p>§<p>Analyzed only in cases who delivered vaginally.</p

Indications for labor induction in the study population.

<p>Indications for labor induction in the study population.</p

Functional Design of Highly Robust and Flexible Thin-Film Encapsulation Composed of Quasi-Perfect Sublayers for Transparent, Flexible Displays

In this study, a structurally and materially designed thin-film encapsulation is proposed to guarantee the reliability of transparent, flexible displays by significantly improving their barrier properties, mechanical stability, and environmental reliability, all of which are essential for organic light-emitting diode (OLED) encapsulation. We fabricated a bioinspired, nacre-like ZnO/Al₂O₃/MgO laminate structure (ZAM) using atomic layer deposition for the microcrack toughening effect. The ZAM film was formed with intentional voids and defects through the formation of a quasi-perfect sublayer, rather than the simple fabrication of nanolaminate structures. The 240 nm thick ZAM-based multibarrier (ZAM-TFE) with a compressively strained organic layer demonstrated an optical transmittance of 91.35% in the visible range, an extremely low water vapor transmission rate of 2.06 × 10^–6 g/m²/day, a mechanical stability enduring a strain close to 1%, and a residual stress close to 0, showing significant improvement of key TFE properties in comparison to an Al₂O₃-based multibarrier. In addition, ZAM-TFE demonstrated superior environmental resistance without degradation of barrier properties in a severe environment of 85 °C and 90% relative humidity (RH). Thus, our structurally and materially designed ZAM film has been well optimized in terms of its applicability as a gas diffusion barrier as well as in terms of its mechanical and environmental reliability. Finally, we confirmed the feasibility of the ZAM-TFE through application in OLEDs. The low-temperature ZAM-TFE technology showed great potential to provide a highly robust and flexible TFE of TFOLEDs

Short cervical lengths initially detected in mid-trimester and early in the third trimester in asymptomatic twin gestations: Association with histologic chorioamnionitis and preterm birth

<div><p>Objective</p><p>To determine whether short cervical lengths (≤20 mm) that were initially detected in mid-trimester and early in the third trimester are independently associated with increased risks of subsequent histologic chorioamnionitis and spontaneous preterm birth (SPTB, defined as a delivery before 34 weeks) in asymptomatic women with twin pregnancies.</p><p>Material and methods</p><p>This is a prospective study including 292 consecutive asymptomatic women with twin gestations. Cervical length measurements were carried out at 20 to 24 weeks’ gestation and at 28 to 32 weeks’ gestation. Both placentas of each twin pair were examined histologically after delivery. The generalized estimation equations models and logistic regression analysis were used for statistical analyses.</p><p>Results</p><p>Multivariable generalized estimation equations analysis revealed that short cervical length at mid-trimester was independently associated with an increased risk for subsequent histologic chorioamnionitis, whereas short cervical length initially detected early in the third trimester was not. By using the likelihood of SPTB as an outcome variable, multivariable logistic regression analysis indicated that short mid-trimester cervical length and histologic chorioamnionitis were independently associated with a greater risk for SPTB. Similarly, based on the multivariable analysis, a short third trimester cervical length was independently and significantly associated with a greater risk for SPTB.</p><p>Conclusions</p><p>In asymptomatic women with twin pregnancies, a short mid-trimester cervical length is independently associated with an increased risk of both subsequent histologic chorioamnionitis and SPTB, whereas a short cervical length initially detected early in the third trimester is independently associated with preterm delivery, but not subsequent histologic chorioamnionitis.</p></div