Diagnosis of intraamniotic inflammation by measuring vaginal interleukin-6 in patients with cervical insufficiency: could amniocentesis be avoided?

BACKGROUND: Cervical insufficiency is a recurrent, passive, and painless dilation of the cervix in the second trimester. The etiology is unclear, but there may be an association with subclinical intraamniotic infection. Interleukin-6 (IL-6) production in the amniotic cavity is induced by bacterial invasion, it is the major proinflammatory cytokine released in response to infection. Although the gold standard method to measure it is through an amniocentesis, the procedure constitutes an invasive technique with several associated risks. The objective of this study is to determine if there is a correlation between intraamniotic and vaginal IL-6 in patients with cervical insufficiency and bulging membranes during the second trimester of pregnancy, in order to avoid an amniocentesis before the rescue cerclage. METHODS: A cohort study was performed in which all patients with cervical insufficiency and bulging membranes admitted into our tertiary hospital between 2019 and 2020 were included, and a control group of asymptomatic women in the second trimester of gestation where studied at the same time. Patients with bulging membranes underwent an amniocentesis to quantify amniotic IL-6, and a sample of vaginal fluid for vaginal IL-6 determination was obtained from both the study and the control group. RESULTS: A total of 20 women were included in each group. Median gestational age at diagnosis was 22 weeks in patients with bulging membranes, and 21 weeks in the control group. Vaginal IL-6 in control group (10.875 pg/mL) is much lower than the study group one (1308.77 pg/ml). In patients with bulging membranes, vaginal IL-6 expression was lower in the vagina than in the amniotic cavity [average IL-6 in the amniotic cavity 26890.07 pg/mL, vs 1308.77 pg/mL in the vagina (p < .01)]. Through a Spearman coefficient correlation rank [rho = 0.709 (p < .001)], there is a positive correlation between amniotic and vaginal IL-6 values. The best value of this correlation was calculated with the ROC curve, being the area under the curve 0.929 (CI 95% 0.721-0.995), and the cutoff of point less than 61.4 pg/ml (sensitivity 83.33%; specificity 92.86%). Patients with vaginal IL-6 < 61.4 pg/ml associated a longer latency time between diagnosis and delivery, a higher neonatal weight and a lower perinatal mortality. Rescue cerclage in vaginal IL-6 < 61.4 pg/ml was the best predictor of good pregnancy outcome. CONCLUSION: There is a correlation between intraamniotic and vaginal IL-6 in patients with cervical insufficiency and bulging membranes during the second trimester of pregnancy. However, further studies are needed in order to considerate the avoidance of an amniocentesis before an emergency cerclage.

Tromboelastometría: ¿determinación centralizada en el laboratorio o prueba a la cabecera del paciente? Experiencia en nuestro hospital como test centralizado / Thromboelastometry: centralized test in the laboratory or point of care testing? Experience in our hospital as centralized test

Introducción. La tromboelastografía es la herramienta que permite medir in vitro las propiedades viscoelásticas de la sangre de una manera dinámica y global, integrando las diferentes fases de la coagulación y fibrinólisis. Existen en el mercado dos dispositivos semiautomatizados: el tromboelastograma y el tromboelastómetro rotacional. Material y métodos. Se ha realizado un estudio observacional descriptivo retrospectivo de las solicitudes de tromboelastometría en nuestro hospital desde la implementación del protocolo con la técnica centralizada desde el laboratorio. Se ha evaluado el número de solicitudes, los servicios peticionarios y el grado de cumplimentación de la petición al laboratorio. Así mismo, hemos realizado una encuesta de satisfacción dirigida al personal facultativo del Servicio de Anestesia y Reanimación. El periodo estudiado fue de julio del 2012 a enero del 2016. Resultados. Desde el establecimiento del protocolo hasta la actualidad se ha producido un incremento y una consolidación de la técnica de tromboelastometría en nuestro hospital. La mayor parte de las solicitudes proceden de los Servicios de Anestesia y Reanimación (36,5%) y Angiología y Cirugía Cardiovascular (30,1%). En cuanto a la encuesta de satisfacción, los resultados obtenidos muestran una aceptación positiva por parte de los facultativos tanto con el protocolo como con los tiempos de respuesta obtenidos. Conclusiones. Estableciendo un protocolo elaborado y consensuado entre el laboratorio y los servicios solicitantes, podemos garantizar el estricto cumplimiento del mismo y que los tiempos de respuesta difieran poco de los obtenidos cuando esta técnica se realiza en la cabecera del paciente, permitiendo así dar un servicio global a todo el hospital (AU)

Introduction. Thromboelastography is the tool that allows in vitro measurement of the viscoelastic properties of the blood in a dynamic and comprehensive way, integrating the different phases of coagulation and fibrinolysis. There are two semi-automated devices on the market: the thromboelastogram and the rotational thromboelastometry analyzer. Material and methods. We have conducted a descriptive observatory retrospective study of the thromboelastography requests in our hospital after the implementation of the protocol. It has been evaluated the number of petitions, the petitioners services and the degree of filling of the application laboratory. Likewise, we have performed a satisfaction survey aimed at the medical staff of the Anesthesia and Resuscitation Service. The studied period was from July 2012 until January 2016. Results. From the protocol introduction in our hospital has been produced an increase and a consolidation of the thromboelastography. Most of the requests came from the Anesthesia and Resuscitation Service (36.5%) and Angiology and Cardiovascular Surgery Service (30.1%). As for the satisfaction survey, the results show a positive acceptance by the medical staff both of the protocol as of the response times obtained. Conclusions. By establishing a protocol elaborated and agreed between the laboratory and the requesting departments, we can guarantee the strict compliance of the same and that the response times only differ a little from the obtained ones when this technique is realized as point of care testing, providing a global service to the whole hospital (AU)

Guía sobre las pruebas de laboratorio en el lugar de asistencia al paciente (POCT) / Point-of-care testing guidance (POCT)

No disponible

Good prognosis of cerclage in cases of cervical insufficiency when intra-amniotic inflammation/infection is ruled out.

OBJECTIVE: To determine if absence of sub-clinical intra-amniotic inflammation improves the prognosis of rescue cerclage in cases of bulging membranes. METHODS: Cohort study with all women with bulging membranes admitted into our hospital between 2009 and 2013. Patients underwent amniocentesis to quantify amniotic glucose, leukocytes, IL-6 and leukocyte esterase levels and for microbiological culture. All patients without intra-amniotic inflammation or sub-clinical chorioamnionitis were proposed a physical examination-indicated cervical cerclage. Those who did not accept were treated with bed rest. RESULTS: We enrolled 31 women. Median gestational age at diagnosis was 23 + 1 (21­25 + 4) weeks. Median interval until delivery was 12 (3­52.5) d. IL-6 had the highest diagnostic accuracy for good prognosis. Patients with IL6 <2.90 ng/ml were diagnosed later in pregnancy and presented a longer interval until delivery (89 versus 4 d), higher gestational age at delivery (35 + 1 versus 23 + 3 weeks) and a lower rate of prematurity (54.5% versus 100%) and perinatal mortality (0% versus 80%) than those with IL-6 ≥2.90 ng/ml. Rescue cerclage and low Il-6 were the best predictors of good outcome. CONCLUSION: IL-6 levels in amniotic fluid may be of clinical value for individualizing the management of patients with bulging membranes for placement of rescue cerclage.