An evaluation into the use of Procalcitonin levels as a biomarker of
bacterial sepsis to aid the management of Intrapartum Pyrexia and
Chorioamnionitis: a prospective observational cohort study
Abstract
Objective: Procalcitonin (PCT) is an established biomarker for bacterial
sepsis in the non-pregnant population. We aimed to evaluate PCT levels
in women and their neonates managed with suspected intrapartum bacterial
sepsis, to determine if PCT could be utilised to optimise diagnosis and
management. Design: Prospective observational cohort study. Setting:
University Hospitals of Bristol and Weston NHS Foundation trust.
Population: 117 women and their neonates managed for suspected
intrapartum sepsis from June-October 2020. Methods: PCT levels were
measured in addition to routine biomarkers white cell count and
c-reactive protein, in women and their neonates during initial septic
screen and follow up blood samples. Placentas underwent detailed
histopathology. Main Outcome Measures: Maternal and neonatal parameters
were used to categorise cases into: ‘high-suspicion bacterial sepsis
(BS),’ ‘equivocal BS’ and ‘low-suspicion BS.’ Kruskal-Wallis test was
performed comparing categories with biomarker values and placental
histology scores. Results: PCT was raised in 6 women in the initial
septic screen sample, compared to 100 with a raised CRP. There was a
significant difference in maternal postnatal PCT results between
‘high-suspicion BS’ and ‘low-suspicion BS’ categories. 71.2% of
placentas showed varying degrees of chorioamnionitis. Conclusions: In
our cohort of women, 94.6% had normal PCT levels whilst in labour at
the time of the septic screen, consistent with the low number of
confirmed bacteraemia. This provides a basis that PCT may complement
clinical judgement and interpretation of already utilised prognostic and
diagnostic tests, in order to improve patient care in the management of
intrapartum sepsis.