Fetal İnflamatuar Yanıt Sendromu Belirteçlerinin Maternal Serum ile Fetal Kord Kanında Ölçülmesi ve Neonatal Sonuçlarla Ilişkisinin Değerlendirilmesi

Abstract

Fetal counterpart of systemic inflammatory response syndrome which is diagnosed by clinical signs and symptoms in adults is fetal inflammatory response syndrome (FIRS). Hematologic abnormalities, cardiac dysfunction, pulmonary injury, renal dysfunction and neurological injury might be seen in cases of FIRS. FIRS occurs in a lot of condition like infections, intrauterine growth restriction, preeclampsia and eclampsia. There is no doubt that FIRS increases fetal mortality and morbidity by causing multiple organ dysfunction. FIRS is classically diagnosed with higher fetal umbilical cord serum Interleukine-6 levels than 11pg/ml. Many substances are known to pass through the placenta. Therefore, markers which increase in fetal blood (in FIRS) will also increase in maternal blood via passing through the placenta. Thus, diagnosis of FIRS will be achieved only by maternal serum sample assessment. Various serum markers like sedimentation, white blood cell count, C-reactive protein, procalcitonin, interleukine-6 (IL-6), interleukine-8 (IL-8), interleukine-1β (IL-1 β), matrix metalloproteinase-8 (MMP-8) have been demonstrated to increase in FIRS in the hitherto literature. Our main aim in this study is to find out the significant markers increased in maternal serum in FIRS by comparing the serum levels of these in maternal and fetal blood. In addition, we plan to find out if there is any statistically significant correlation between these significant increased markers and neonatal outcomes. Of 98 pregnant women who were enrolled to the study, 51 of them had risk factors in the concept of FIRS and these 51 patients were delivered prematurely due to antenatal complications of pregnancy. The other group consisted of 47 pregnant women whose antenatal follow-up were completely normal. The two groups of patients were similar compared to their main baseline characteristics. We obtained maternal and fetal blood samples at the same time after the extraction of the fetus during c-section or vaginal birth. Afterwards, FIRS markers were measured by assessing these blood samples. IL-6, IL-8, IL-1, TNF-α levels had intermediate positive correlation which was statistically significant between maternal and fetal blood (r=0,485; 0,443; 0,639; 0,377 respectively; p=0,001). Maternal IL-6 and IL-1 levels had higher sensitivity values when predicting good neonatal outcomes (AUC=0,247;0,246; respectively; p=0,006). Fetal umbilical cord procalsitonin values had the highest sensitivity rates in terms of predicting the poor neonatal outcomes(AUC=0,864; p˂0,001). In order to diagnose FIRS, it should be better to use percentiles matched with the gestational week of the fetus rather than using a single cut-off value. In addition, it is important to evaluate the fetusus considering their gestational age while interpreting their FIRS markers. As a conclusion, combining other associated markers of FIRS rather than using just one of them will provide more accurate diagnosis of FIRS.