Diagnostic Accuracy of Amniotic Level of Tumour Necrosis Factor (Tnf-α) as a Marker of Infection in Preterm Labor with Premature Ruptured of Membranes

Objectives: This study was designed to: 1) assess bacterial colonization among patients with premature rupture of membranes (PROM) whether preterm or term. 2) Measure amniotic fluid level of TNF-α among patients with PROM to identify its value in the diagnosis of bacterial colonization (infection). Patients and Methods: Case-control study carried out on 60 patients suffering from premature rupture of membranes and comparing them with another 60 normal pregnant women attending full term vaginal delivery (control group). All patients and control group were subjected to medical history, general examination, sterile speculum examination, high vaginal swab obtained from the posterior fornix during sterile speculum examination and transferred within one hour to bacteriological lab for cultures, 2D real time transabdominal ultrasonography, blood sample for random blood sugar, com-plete blood count, and estimation of TNF-α level in amniotic fluid. Results: Bacterial growth was identified in73%of cases in preterm group of PROM. In full term PROM group 78% of cases were positive for bacterial growth. And only 20% of control group (with intact membrane) were positive for bac-terial growth. Laboratory assessment of the TNF-α values in the studied group, revealed that TNF-α values among the preterm PROM group were (170-200 ng/mL) with mean value of 188 ng/mL, while in the full term PROM group were (30-170 ng/mL) with mean value of 118 ng/mL. In the control group all the values were 10 ng/mL. It was also revealed that in the preterm PROM the cases with positive cultures showed significantly higher values ranging from 180-200 ng/ml with a mean of 193 ng/mL, while in culture negative cases the range was 170-180 ng/mL with a mean of 175 ng/mL. As for the full term PROM group, cases with positive culture values ranged from 80-170 ng/mL with a mean of 137 ng/mL, while in culture negative cases the range was 30-80 ng/mL with a mean of 58 ng/mL overall, a value above 130 ng/mL indicates bacterial colonization. Conclusion: Bacterial colonization was not different between preterm and full term PROM. TNF-α value was significantly high with bacteria positive preterm and term PROM cases, whereas among the control group TNF-α value were insignificant TNF-α is a potential predictor of infection induced rupture of membranes. Value above 130ng/mL in full term PROM diagnoses those with positive bacterial cultures.