The significance of TNF‐α and MMP‐8 concentrations in non‐invasively obtained amniotic fluid predicting fetal inflammatory response syndrome

OBJECTIVE: To determine the significance of tumor necrosis factor‐α (TNF‐α) and matrix metalloproteinase‐8 (MMP‐8) in vaginally obtained amniotic fluid predicting fetal inflammatory response syndrome (FIRS) after preterm premature rupture of membranes (PPROM). METHODS: In this prospective case–control study, TNF‐α and MMP‐8 concentrations were evaluated in vaginally obtained amniotic fluid from women with PPROM at 22–34 weeks of pregnancy. Biomarkers' concentrations were determined using an enzyme‐linked immunosorbent assay. Patients were divided into two groups: the FIRS group (cord blood interleukin‐6 > 11 pg/ml or histological funisitis) and the non‐FIRS group (without these findings). The data were analyzed using R package (R–4.0.5). RESULTS: The median TNF‐α and MMP‐8 concentrations in amniotic fluid from the 145 women included in the study were higher in the FIRS group than in the non‐FIRS group. The area under the curve of TNF‐α and MMP‐8 was 0.77 and 0.75, respectively. The TNF‐α concentration cut‐off predicting FIRS was 89.20 pg/ml and was 170.76 pg/ml for MMP‐8. In regression analysis, MMP‐8 concentration was an independent predictor for FIRS. An MMP‐8 concentration greater than 170 ng/ml and a TNF‐α concentration greater than 89 pg/ml increased the odds of FIRS 7.62 and 14.92 times, respectively. CONCLUSIONS: MMP‐8 and TNF‐α concentrations in vaginally obtained amniotic fluid may be good predictors for FIRS after PPROM before 34 weeks of pregnancy. The non‐invasive amniotic fluid analysis could be an alternative method to invasive amniocentesis.