Publication | Closed Access
The Association of Occult Amniotic Fluid Infection With Gestational Age and Neonatal Outcome Among Women in Preterm Labor
443
Citations
0
References
1992
Year
Fetal MedicineGynecologyAnaerobic CulturingVaginitisPositive Af CulturesObstetricsInfection ControlPublic HealthAerobic CulturingPositive CulturesPreterm LaborGestational AgeMaternal HealthNewborn MedicineMaternal-fetal MedicineClinical MicrobiologyNeonatal OutcomeAbortionAntibioticsPediatricsPregnancyClinical InfectionPreterm BirthMicrobiologyMedicine
Occult amniotic fluid infection in preterm labor may be a treatable cause of preterm birth, potentially reducing perinatal morbidity and mortality. The study evaluated how gestational age and neonatal outcomes relate to amniotic fluid bacteria by collecting AF from women with intact membranes in idiopathic preterm labor. Positive amniotic fluid cultures were detected in 19 % of women, were more frequent at earlier gestational ages, and were linked to earlier delivery, lower birth weight, and increased risk of respiratory distress syndrome, bronchopulmonary dysplasia, and neonatal death.
To evaluate the relationships between gestational age, neonatal outcome, and amniotic fluid (AF) bacteria, we obtained AF from women with intact membranes in idiopathic preterm labor. Positive cultures were obtained from 20 (19%) of 105 women. The frequency of positive cultures was inversely related to gestational age: 23-26 weeks, nine of 20; 27-30 weeks, four of 24; and 31-34 weeks, seven of 61 (Χ2 for trend, P < .001).Fusobacterium nucleatum, Bacteroides ureolyticus,andUreaplasma urealyticumwere the most common isolates. Facultative and anaerobic bacteria were more commonly isolated from women at less than 30 weeks' gestation, andUreaplasma urealyticumwas commonly isolated at greater than 30 weeks' gestation. Forty percent of the patients identified as having positive AF facultative and anaerobic cultures by the research laboratory had negative cultures in the clinical laboratory. Clinical characteristics and maternal white blood cell count and differential did not differ between women with and without positive cultures. Elevated C-reactive protein levels and a positive AF Gram stain were the two most sensitive and specific methods to predict positive AF cultures. Women with positive cultures delivered a median of 1.0 day after enrollment, compared with 28.5 days for women with negative cultures. The median gestational age at delivery for women with positive cultures was 27.5 weeks, and the median birth weight was 866 g. Positive AF cultures were associated with respiratory distress syndrome, bronchopulmonary dysplasia, and neonatal death. If occult AF infection among women in preterm labor is a treatable cause of preterm birth, then treatment could markedly reduce both perinatal morbidity and mortality.(Obstet Gynecol 1992;79:351-7)