International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Volume 6 Issue 7, July 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY High Maternal Serum Interleukin-8 and Endocervical Neutrophil Cell Count as Risk Factors for Preterm Labor Anak Agung Gede Putra Wiradnyana 1 , Tjokorda Gde Agung Suwardewa 2 , I Ketut Surya Negara 3 1, 2, 3 Maternal-Fetal Division Staff, Obstetrics and GynaecologyDepartment, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali Abstract: Background : Preterm laborincidence ratesare still high invariouscountries including Indonesia ranging from 10-20 %. The definitecause ofpreterm labor remains unknown. IL-8andneutrophilcell are thought to play important roleinthe pathogenesis ofpreterm labor. Objective : Todeterminethe role of high maternal serum IL-8andendocervical neutrophilcell count as risk factorsforpreterm labor. Study design : This is a case control study, involving46 preterm labor cases and 46 preterm pregnancy controls. Results : High level ofIL- 8in maternalserumincreased the risk ofpreterm labor by 96times( OR =95.56; 95 % CI=22.38-40.87, p = 0.001) compared tolow level maternal serumIL–8.High number endocervical neutrophil cellsincreased the risk ofpreterm labor by 68times( OR =68.08; 95 % CI=16.84-275.21, p = 0.001) compared tothe low numberof neutrophil cells. Maternal serum IL-8 is amoredominantrisk factor forpreterm labor comparedto endocervical neutrophil. Conclusion : High level of maternal IL - 8 and endocervical neutrophil cells increase the risk of preterm labor by 96 times and 68 times respectively. Maternal serum IL - 8 is a more dominant risk factor for preterm labor compared to endocervical neutrophil cells. Keywords: IL - 8, endocervical neutrophil cell, preterm labor 1. Introduction The advances of knowledge in this 20th century has opened our eyes that preterm infants are in need for special treatment, supported by rapid development of neonatal intensive care. Prematurity has been the main problem, due to its contribution for high neonatal mortality rate. Neonatal mortality is one indicator of health service system achievement of a country, in national or international context. 1 The high mortality rate is related to organ maturity such as lungs, nervous system, and gastrointestinal system. In western country, 80% of neonatal deaths are caused by prematurity, where as 10% of the surviving neonates suffer from long-term morbidity. 2 Preterm deliveries in many countries including Indonesia remain high, with varying incidence rate. In United States, preterm labor incidence in 1981 was 9,4% which increased to 10,6%in 1990, to 11,6% in 2000, and to 11,9% in 2001. 3 In Indonesia, preterm labor ranges from 10-20%. At Dr. Hasan Sadikin General Hospital, preterm labor rate was 13,4% in year 2000. 4 At Sanglah Hospital Denpasar, the rate was 7,44% in 1996, while in 1999 Ardhana found 431 out of 4.984 deliveries (8,65%) were preterm labor. As also reported by Udiarta in 2003, preterm labor rates at Sanglah General Hospital were 6,82% in 2001, 7,50% in 2002, and 11,4% in 2003. 5 The etiology of preterm delivery are often well defined. But in some cases, the cause are difficult to explain. Some factors contribute to preterm labor, such as maternal factors, fetal and placental factors, and also other contributing factors such as socioeconomic status. In some cases, single risk factor can be seen, such as overdistention, rupture of membrane or trauma. In his study, Cox (1989) reported that endotoxin (lipopolysaccharide) could enter amniotic fluid, inducing cytokines and prostaglandines production by decidua, which lead to labor (uterine contraction). Lockwood (2001) proposed that relationship exists between preterm labor and inflammation process in decidua, chorion, and amnion. 6 Many cases of preterm labor are caused by pathogenic process involving various chemical mediators that induce uterine contraction and cervical changes. 2 About 70-80% of preterm labors are spontaneous and are significantly related to vaginal and cervical infection, and also choriooamniotic infection. 7 Currently, the effect and relationship between cytokines and preterm labor are the most extensively studied. The interaction between cytokines like tumor necroting factor - α (TNF - α), interleukin - 1 (IL - 1), interleukin - 6 (IL - 6), interleukin - 8 (IL - 8) and their activity on arachidonic acid metabolism may play major role in this infectio-preterm labor relationship. 8 Patients with clinical signs and symptoms of preterm delivery show increase in various cytokines; thus, cytokines may play major role in preterm labor initiation. One of inflammatory cytokine in maternal serum is IL-8. Many studies have reported that increased serum IL-8 is related to preterm labor initiation, even though the results are still varied. 9.10 Other studies reported that in women with spontaneous preterm labor and intact membrane, when more than 5 endocervical neutrophil cells per field (400 times magnification), infection or inflammation in amniotic fluid is likely. 11 Non-invasive examination in Dr Hasan Sadikin Hospital Bandung, which combined the value ofo vaginal acidity and neutrophil cell count, had achieved 83,3% specificity and 75% accuracy for predicting preterm labor. 12 These biologic markers are increased as showed by vaginal swab and gram staining. 13 A good diagnostic predictor will not only prevent the usage of tocolytiv therapy, but also decrease the rate of hospital Paper ID: ART20175894 DOI: 10.21275/ART20175894 2244