THE ROLE OF SUBCLINICAL INFECTION AND CYTOKINES IN PRETERM PARTURITION

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The laboratory concluded the following studies: 1. Interleukin-6 concentrations in umbilical cord plasma identify infants at risk for the development of white matter lesions associated with periventricular leukomalacia (PVL): PVL is a common white matter lesion of the central nervous system of preterm neonates and a major risk factor for cerebral palsy. A series of studies have been designed to test the hypothesis of whether cytokine-mediated neural injury is responsible for this condition. Investigators of the Branch found that IL-6 determinations in umbilical cord can identify infants at risk for PVL-associated lesions. 2. Two thirds of spontaneous abortion/fetal deaths after genetic midtrimester amniocentesis are the result of a pre-existing subclinical inflammatory process of the amniotic cavity: Pregnancy loss after midtrimester amniocentesis occurs in 0.05% of cases and generally has been attributed to the procedure. Interleukin-6 (IL-6) is a cytokine normally present in human amniotic fluid and its concentration increases in the course of infection. The Branch established that of among women undergoing midtrimester amniocentesis, those who subsequently had a spontaneous abortion/fetal demise had a higher amniotic fluid concentration of IL-6 than those who had a normal delivery at term. This suggests that pre-existing inflammatory process is an important risk factor for pregnancy loss and that amniotic fluid IL-6 concentration can identify patients at risk. 3. Prostaglandins: Cause or consequence of labor?: Prostaglandins have been considered the key mediators for the onset of labor for all mammalian species. Recently, intense debate has developed as to whether prostaglandins participate in the initiation of labor or are released as a consequence of labor. A crucial issue in this debate is whether an increase in prostaglandins biosynthesis occurs prior to the onset of labor. This question has never been addressed in humans. Consequently, the Branch conducted a study to determine whether amniotic fluid prostaglandin concentrations increase prior to the onset of labor in humans. This study established that a significant increase in amniotic fluid concentrations of PGE and PGF occurred prior to the onset of spontaneous labor and that an additional increase in amniotic fluid concentrations PGE and PGF was found in early labor. These data support a role for prostaglandins in the initiation of human parturition.