MATERNAL PLASMA C-REACTIVE PROTEIN: A PREDICTIVE TOOL FOR PRETERM DELIVERY

BACKGROUND C-reactive protein (CRP) is a sensitive marker of systemic inflammation and maternal plasma concentrations of C-reactive protein have been studied as an aid in diagnosing subclinical infection in pregnant women who experience preterm labour and premature rupture of membranes.Objectives-To study the association of plasma C-reactive protein levels in early pregnancy with subsequent preterm delivery. MATERIALS AND METHODSThis study was carried out in the Department of obstetrics and gynaecology, Lalla-Ded hospital, Srinagar Kashmir from July 2008 to November 2010.A prospective nested case-control approach was used, in which cases were participants who experienced preterm delivery and controls were those women who delivered at 37 weeks or more.200 pregnant women with singleton pregnancy were recruited for study and were followed till delivery.Maternal plasma C-reactive protein levels were measured in early pregnancy (<22 weeks of gestation) and were correlated with the time of delivery (preterm/term).The characteristics of cases and controls were compared by using descriptive statistics.Comparative evaluation was done by using Chi-Square test and Odds ratio.All pvalues of <0.05 were regarded as significant.Conditional logistic regression analysis was performed to evaluate the risk of preterm delivery. RESULTSWe found statistically significant differences in the C-reactive protein levels measured in early pregnancy between the women who delivered preterm and those delivering at term.Plasma CRP levels were higher in cases than in controls.Mean CRP level was 5.2±2.9mg/L in cases and 2.4±1.2mg/L in controls.Median CRP concentration was also higher in cases (4.8 mg/L) than in controls (2.0 mg/L).The sensitivity, specificity, PPV and NPV of CRP in predicting preterm delivery were found to be 61.0%,88.7%, 58.1% and 89.8% respectively, at a cut-off value of 3.6 mg/L. CONCLUSIONElevated CRP level in early pregnancy is associated with preterm delivery.Therefore, measurement of plasma CRP level in early pregnancy can serve as a predictive tool for subsequent preterm delivery.

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