Predicting Funisitis and Neonatal Sepsis

Objectives: To evaluate the usefulness of serum C-reactive protein (CRP) in women with preterm prelabour rupture of membranes (PPROM) in the prediction of funisitis and early-onset neonatal sepsis (EONS), to determine a CRP cutoff value for their prediction, and to identify other significant risk factors associated with funisitis and EONS. Methods: This was a retrospective study conducted in a tertiary hospital in Hong Kong. Women with a singleton pregnancy at 24 to 34 weeks of gestation and had PPROM were recruited between January 2011 and December 2015. Maternal serum CRP level, histopathological diagnosis of the placenta, and incidence of EONS were evaluated. Results: Among the 123 women recruited, funisitis was present in 21.1% of the women and EONS in 19.5% of the newborns. Maternal serum CRP level was associated with funisitis that was in turn associated with EONS. There was, however, no significant association between maternal serum CRP and EONS. Using a CRP cutoff value of 7.65 mg/l to predict funisitis, the sensitivity, specificity, positive predictive value, and negative predictive value were 65.4%, 78.4%, 44.7%, and 89.4%, respectively. The gestational age at delivery was the most significant risk factor for funisitis and EONS. Birth weight and Apgar score were significantly lower in women with funisitis and newborns with EONS than those without. Other risk factors for EONS included a positive high vaginal swab and placental swab cultures and the presence of group B Streptococcus in a high vaginal swab. Conclusions: Maternal serum CRP may be helpful in the prediction of funisitis in women with PPROM. Nonetheless, the study did not show any association between maternal serum CRP and EONS. The CRP level should be interpreted with caution in a clinical setting. The gestational age at delivery was the most significant determining factor for funisitis and EONS. Hong Kong J Gynaecol Obstet Midwifery 2017; 17(2):79-85