# The clinic application of mNGS and ENA-78 assays to identify intra-amniotic infection/inflammation

## TL;DR

This study shows that mNGS and ENA-78 tests in amniotic fluid can help detect infection/inflammation and predict outcomes of cervical cerclage in preterm labor.

## Contribution

The study introduces mNGS and ENA-78 as novel diagnostic tools for intra-amniotic infection/inflammation and emergency cerclage outcomes.

## Key findings

- mNGS detected microbial invasion of the amniotic cavity more effectively than microbial culture.
- ENA-78 levels were significantly higher in patients with intra-amniotic inflammation.
- Patients with infection/inflammation had worse pregnancy outcomes after cervical cerclage.

## Abstract

The objective of this study is to explore whether metagenomic next-generation sequencing (mNGS) and Epithelial Neutrophil Activating Peptide-78 (ENA-78) assays in the amniotic fluid (AF) of patients with preterm labor (PTL) could be employed for diagnosing intra-amniotic infection/inflammation (IAI/I) and predict the outcomes of emergency cerclage in women with cervical insufficiency(CI).

AF samples from 40 patients were subjected to PTL were subjected to mNGS and microbial culture to diagnose intra-amniotic infection known as microbial invasion of the amniotic cavity (MIAC); ELISA was used to analyze ENA-78 levels for prediction of intra-amniotic inflammation (IAI). Pregnancy outcomes were compared, the predictive performance of mNGS and ENA-78 were assessed to evaluate the efficacy of emergency cervical cerclage.

The diagnosis rate of MIAC was higher with mNGS (17.5%) compared to microbial culture (2.5%). AF ENA-78 levels were significantly higher in IAI patients than in non-IAI/I patients. ENA-78 demonstrated certain accuracy in identifying IAI, with sensitivity and specificity of 73.3% and 100%, respectively. Compared with non-IAI/I patients, patients with MIAC or IAI exhibited poor pregnancy outcomes after cervical cerclage.

mNGS and ENA-78 assays are valuable means for assessing the state of infection/inflammation in the amniotic cavity and predicting the outcomes of emergency cerclage.