Role of Maternal Plasma Procalcitonin Level in The Diagnosis of Subclinical Chorioamnionitis in Pregnancy Complicated by Preterm Prelabor Rupture of Membrane

Background: At any time during pregnancy, intrauterine infection is an important risk factor for neonatal sepsis and is a frequent cause of mortality and morbidity in newborn infants. Objectives: to evaluate maternal plasma procalcitonin levels in the pregnant women complicated with preterm prelabor rupture of membrane and prelabor rupture of membrane at term and compare it with healthy pregnant women at preterm and term and determine the role of procalcitonin in the diagnosis of subclinical chorioamnionitis in PPROM cases. Study design: A prospective case-control study. Patients and Methods: One hundred women 18_40 years old with singleton pregnancies were seen in Al-Yarmuk teaching hospital between September 2015 to August 2016. Women were divided into 4 groups according to weeks of gestation and membrane status (intact or ruptures).  Group 1 included 30 women with gestational age between 28-36 weeks and membrane rupture without uterine contraction.  Group 2 included 25 women with rupture membrane at term (37-41weeks) without uterine contraction.   Group 3 included 20 healthy women at preterm (28 - 36 weeks) with intact membrane.  Group 4 included 25 healthy women at term (37-41weeks) not in labor with intact membrane; the last two groups represented the control groups. In all groups, we measured maternal plasma procalcitonin level, white blood cells(WBC), C reactive protein (CRP), send placenta for histopathology and check birth weight of the baby and sign of neonatal infection. Results: the mean PCT level in the women of group one (the PPROM group) was higher (0.171 ±0.078) ng/ml than PROM and control groups with a p-value of <0,001. In addition, it was more significant in the detection of histological chorioamnionitis in PPROM patients than neonatal infection, as the cut off value was 0.08, with high sensitivity 96%, specificity 82%, positive predictive value (PPV) 84.2% and negative predictive value (NPV) 95.3%. Conclusions: Maternal plasma PCT level was significantly higher in PPROM than in term PROM and controls groups.    PCT was more significant in predicting histological chorioamnionitis than neonatal sepsis.  PCT was superior to CRP and WBC count in detecting subclinical intraamniotic infection by its ability to detect histological chorioamnionitis and neonatal sepsis.