Maternal Serum Amyloid A level in Pregnancies Complicated with Preterm Premature Rupture of Membranes

Background: serum amyloid A (SAA) is a cytokine-inducible acute-phase reactant whose plasma concentrations can exceed 1 mg/mL during an acute-phase response (500 to 1000 fold of plasma levels  greater than in the non inflammatory state) thus representing an ideal marker for clinical use. Preterm premature rupture of membranes (PPROM) complicates only 2% of pregnancies but is associated with 40% of preterm deliveries and can result in significant neonatal morbidity (Prematurity, sepsis and pulmonary hypoplasia) and mortality. Aim of the work: this study aimed to find out association between maternal serum amyloid A level and preterm premature rupture of membranes. Also to compare SAA, CRP levels, N/L ratio in the study group. Patients and methods: this study is a cross sectional study conducted in Ain Shams University Maternity Hospital from December 2015 – December 2016 on 58 pregnant women. Women have been allocated in this study, represented in two groups: 1- Study group: including 29 women complaining of preterm premature rupture of membranes. 2- Control group: including 29 women as control group with no complain. Venous blood sample was taken from each participant (study group within 1hour from onset of PPROM, control group during their follow up visit to the clinics). Serum amyloid A, Micro C reactive pretein, total WBCs and neutrophil/lymphocyte ratio (NLR) were calculated.  Results: the results point out that PPROM cases had significantly lower GA and APGAR scores at 1 min and more prone to neonatal sepsis which may lead to death. PPROM women have significantly higher total WBC, N/L ratio CRP and serum amyloid A. There were significant positive correlations between amyloid-A, N/L ratio& CRP in both groups. Serum amyloid A level above 2 ng/ml is a risk factor for PPROM and low Apgar score at 1 min. but has low predictive value. CRP with cut off value 5.0 mg/dl has better predictive value in discrimination between PPROM group and control group.Conclusion: Results assessed possible association between maternal SAA, maternal and fetal parameters in pregnancies complicated with PPROM.