Startseite The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis
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The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis

  • Elif E. Gultekin-Elbir , Catherine Ford und Mehmet R. Genç EMAIL logo
Veröffentlicht/Copyright: 28. Februar 2019
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 47 Heft 5

Abstract

Objective

To assess the value of incorporating amniotic fluid (AF) analysis in the management of patients with clinical chorioamnionitis.

Methods

This was a retrospective cohort study of all women carrying a singleton fetus and managed at our center between 2000 and 2009. We included only those women suspected of chorioamnionitis based on one or more of the following: (1) uterine tenderness, (2) maternal fever, (3) maternal and/or fetal tachycardia and (4) purulent discharge. The management was deemed to be justified if (1) pregnancy was terminated <24 weeks and histology confirmed chorioamnionitis; (2) delivery was performed expeditiously after initial assessment and histology confirmed chorioamnionitis; (3) delivery was delayed for 2–7 days and the patient completed a course of antenatal steroids before 34 weeks; and (4) delivery was delayed ≥7 days and histology was not indicative of chorioamnionitis, or delivery occurred after 37 weeks. Univariate and logistic regression analyses were used as appropriate.

Results

Of the 77 women with suspected chorioamnionitis, AF analysis was performed in 43 (55.8%) cases, and the management was justified in 63 (81.8%) cases based on the aforementioned criteria. Stepwise regression analysis confirmed AF analysis as a predictor of justified management. The rates of composite morbidity, neonatal sepsis, neonatal death and admissions to neonatal intensive care unit were lower in the justified management group.

Conclusion

Incorporation of AF analysis into clinical assessment does improve the management of suspected chorioamnionitis.

Keywords: amniotic fluid analysis; chorioamnionitis; clinical assessment; composite morbidity; maternal fever; maternal morbidity; maternal sepsis; neonatal morbidity; neonatal sepsis

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, Watterberg K, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016;127:426–36.10.1097/AOG.0000000000001246Suche in Google Scholar

2. MacVicar J. Chorioamnionitis. Clin Obstet Gynecol 1970;13:272–90.10.1097/00003081-197006000-00005Suche in Google Scholar

3. Gibbs RS, Castillo MS, Rodgers PJ. Management of acute chorioamnionitis. Am J Obstet Gynecol 1980;136:709–13.10.1016/0002-9378(80)90445-7Suche in Google Scholar

4. Gibbs RS, Blanco JD, St Clair PJ, Castaneda YS. Quantitative bacteriology of amniotic fluid from women with clinical intra-amniotic infection at term. J Infect Dis 1982;145:1–8.10.1093/infdis/145.1.1Suche in Google Scholar

5. Hollander D. Diagnosis of chorioamnionitis. Clin Obstet Gynecol 1986;29:816–25.10.1097/00003081-198612000-00008Suche in Google Scholar

6. Gilstrap LC 3rd, Cox SM. Acute chorioamnionitis. Obstet Gynecol Clin North Am 1989;16:373–9.10.1016/S0889-8545(21)00165-0Suche in Google Scholar

7. Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol 1993;36:795–808.10.1097/00003081-199312000-00004Suche in Google Scholar PubMed

8. Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010;37:339–54.10.1016/j.clp.2010.02.003Suche in Google Scholar PubMed PubMed Central

9. Randis TM, Polin RA, Saade G. Chorioamnionitis: time for a new approach. Curr Opin Pediatr 2017;29:159–64.10.1097/MOP.0000000000000466Suche in Google Scholar PubMed

10. Oh KJ, Kim SM, Hong JS, Maymon E, Erez O, Panaitescu B, et al. Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation. Am J Obstet Gynecol 2017;216:604.e1–604.e11.10.1016/j.ajog.2017.02.035Suche in Google Scholar PubMed PubMed Central

11. Romero R, Chaemsaithong P, Korzeniewski SJ, Kusanovic JP, Docheva N, Martinez-Varea A, et al. Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection? J Perinat Med 2016;44:23–32.10.1515/jpm-2015-0044Suche in Google Scholar

12. Curtin WM, Katzman PJ, Florescue H, Metlay LA. Accuracy of signs of clinical chorioamnionitis in the term parturient. J Perinatol 2013;33:422–8.10.1038/jp.2012.135Suche in Google Scholar

13. Apantaku O, Mulik V. Maternal intra-partum fever. J Obstet Gynaecol 2007;27:12–5.10.1080/01443610601016644Suche in Google Scholar

14. Yancey MK, Zhang J, Schwarz J, Dietrich CS 3rd, Klebanoff M. Labor epidural analgesia and intrapartum maternal hyperthermia. Obstet Gynecol 2001;98:763–70.10.1097/00006250-200111000-00010Suche in Google Scholar

15. Arendt KW, Segal BS. The association between epidural labor analgesia and maternal fever. Clin Perinatol 2013;40:385–98.10.1016/j.clp.2013.06.002Suche in Google Scholar

16. Romero R, Emamian M, Quintero R, Wan M, Hobbins JC, Mazor M, et al. The value and limitations of the Gram stain examination in the diagnosis of intraamniotic infection. Am J Obstet Gynecol 1988;159:114–9.10.1016/0002-9378(88)90503-0Suche in Google Scholar

17. Romero R, Quintero R, Nores J, Avila C, Mazor M, Hanaoka S, et al. Amniotic fluid white blood cell count: a rapid and simple test to diagnose microbial invasion of the amniotic cavity and predict preterm delivery. Am J Obstet Gynecol 1991;165:821–30.10.1016/0002-9378(91)90423-OSuche in Google Scholar

18. Bujold E, Morency AM, Rallu F, Ferland S, Tétu A, Duperron L, et al. Bacteriology of amniotic fluid in women with suspected cervical insufficiency. J Obstet Gynaecol Can 2008;30:882–7.10.1016/S1701-2163(16)32967-XSuche in Google Scholar

19. Kidokoro K, Furuhashi M, Kuno N, Ishikawa K. Amniotic fluid neutrophil elastase and lactate dehydrogenase: association with histologic chorioamnionitis. Acta Obstet Gynecol Scand 2006;85:669–74.10.1080/01443610600604432Suche in Google Scholar

20. Romero R, Yoon BH, Mazor M, Gomez R, Gonzalez R, Diamond MP, et al. A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes. Am J Obstet Gynecol 1993;169:839–51.10.1016/0002-9378(93)90014-ASuche in Google Scholar

21. Romero R, Yoon BH, Mazor M, Gomez R, Diamond MP, Kenney JS, et al. The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and gram stain in patients with preterm labor and intact membranes. Am J Obstet Gynecol 1993;169:805–16.10.1016/0002-9378(93)90009-8Suche in Google Scholar

22. Cobo T, Kacerovsky M, Palacio M, Hornychova H, Hougaard DM, Skogstrand K, et al. A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes: analyses of multiple proteins in the amniotic fluid. J Matern Fetal Neonatal Med 2012;25:1995–2001.10.3109/14767058.2012.666592Suche in Google Scholar

23. Romero R, Jimenez C, Lohda AK, Nores J, Hanaoka S, Avila C, et al. Amniotic fluid glucose concentration: a rapid and simple method for the detection of intraamniotic infection in preterm labor. Am J Obstet Gynecol 1990;163:968–74.10.1016/0002-9378(90)91106-MSuche in Google Scholar

24. Ford C, Genç MR. Optimized amniotic fluid analysis in patients suspected of intrauterine infection/inflammation. J Perinat Med 2011;40:33–7.10.1016/j.ajog.2010.10.650Suche in Google Scholar

25. Chaiyasit N, Romero R, Chaemsaithong P, Docheva N, Bhatti G, Kusanovic JP, et al. Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation. J Perinat Med 2017;45:539–50.10.1515/jpm-2016-0344Suche in Google Scholar PubMed PubMed Central

26. Sperling RS, Ramamurthy RS, Gibbs RS. A comparison of intrapartum versus postpartum treatment of intrapartum infection. Obstet Gynecol 1987;70:861–5.Suche in Google Scholar

27. Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors of intra-amniotic infection. Obstet Gynecol 1989;73:571–5.Suche in Google Scholar

28. Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015;213:29–52.10.1016/j.ajog.2015.08.040Suche in Google Scholar PubMed PubMed Central

29. Palmsten K, Nelson KK, Laurent LC, Park S, Chambers CD, Parast MM. Subclinical and clinical chorioamnionitis, fetal vasculitis, and risk for preterm birth: a cohort study. Placenta 2018;67:54–60.10.1016/j.placenta.2018.06.001Suche in Google Scholar PubMed PubMed Central

30. Romero R, Kim YM, Pacora P, Kim CJ, Benshalom-Tirosh N, Jaiman S. The frequency and type of placental histologic lesions in term pregnancies with normal outcome. J Perinat Med 2018;46:613–30.10.1515/jpm-2018-0055Suche in Google Scholar PubMed PubMed Central

31. Horvath B, Lakatos F, Tóth C, Bödecs T, Bódis J. Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period. J Perinat Med 2014;42:441–7.10.1515/jpm-2013-0186Suche in Google Scholar PubMed

32. Gupta M, Mestan KK, Martin CR, Pearson C, Ortiz K, Fu L, et al. Impact of clinical and histologic correlates of maternal and fetal inflammatory response on gestational age in preterm births. J Matern Fetal Neonatal Med 2007;20:39–46.10.1080/14767050601156861Suche in Google Scholar PubMed

33. Guzick DS, Winn K. The association of chorioamnionitis with preterm delivery. Obstet Gynecol 1985;65:11–6.Suche in Google Scholar

34. Hoskins IA, Johnson TR, Winkel CA. Leukocyte esterase activity in human amniotic fluid for the rapid detection of chorioamnionitis. Am J Obstet Gynecol 1987;157:730–2.10.1016/S0002-9378(87)80039-XSuche in Google Scholar

35. Romero R, Kadar N, Hobbins JC, Duff GW. Infection and labor: the detection of endotoxin in amniotic fluid. Am J Obstet Gynecol 1987;157:815–9.10.1016/S0002-9378(87)80061-3Suche in Google Scholar

36. Romero R, Chaemsaithong P, Korzeniewski SJ, Tarca AL, Bhatti G, Xu Z, et al. Clinical chorioamnionitis at term II: the intra-amniotic inflammatory response. J Perinat Med 2016;44:5–22.10.1515/jpm-2015-0045Suche in Google Scholar PubMed PubMed Central

37. Gervasi MT, Romero R, Bracalente G, Erez O, Dong Z, Hassan SS, et al. Midtrimester amniotic fluid concentrations of interleukin-6 and interferon-gamma-inducible protein-10: evidence for heterogeneity of intra-amniotic inflammation and associations with spontaneous early (<32 weeks) and late (>32 weeks) preterm delivery. J Perinat Med 2012;40:329–43.10.1515/jpm-2012-0034Suche in Google Scholar PubMed PubMed Central

38. Martinez-Varea A, Romero R, Xu Y, Miller D, Ahmed AI, Chaemsaithong P, et al. Clinical chorioamnionitis at term VII: the amniotic fluid cellular immune response. J Perinat Med 2017;45:523–38.10.1515/jpm-2016-0225Suche in Google Scholar PubMed PubMed Central

39. Chaemsaithong P, Romero R, Docheva N, Chaiyasit N, Bhatti G, Pacora P, et al. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intra-amniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes. J Matern Fetal Neonatal Med 2017;31:228–44.10.1080/14767058.2017.1281904Suche in Google Scholar PubMed PubMed Central

40. Musilova I, Bestvina T, Hudeckova M, Michalec I, Cobo T,Jacobsson B, et al. Vaginal fluid IL-6 concentrations as a point-of-care test is of value in women with preterm PROM. Am J Obstet Gynecol 2016;215:619. e1–e12.10.1016/j.ajog.2016.07.005Suche in Google Scholar PubMed

41. Holst RM, Mattsby-Baltzer I, Wennerholm UB, Hagberg H, Jacobsson B. Interleukin-6 and interleukin-8 in cervical fluid in a population of Swedish women in preterm labor: relationship to microbial invasion of the amniotic fluid, intra-amniotic inflammation, and preterm delivery. Acta Obstet Gynecol Scand 2005;84:551–7.10.1097/01.ogx.0000182908.93757.f5Suche in Google Scholar

42. Jacobsson B, Mattsby-Baltzer I, Hagberg H. Interleukin-6 and interleukin-8 in cervical and amniotic fluid: relationship to microbial invasion of the chorioamniotic membranes. BJOG 2005;112:719–24.10.1111/j.1471-0528.2005.00536.xSuche in Google Scholar PubMed

43. Gravett MG, Thomas A, Schneider KA, Reddy AP, Dasari S, Jacob T, et al. Proteomic analysis of cervical-vaginal fluid: identification of novel biomarkers for detection of intra-amniotic infection. J Proteome Res 2007;6:89–96.10.1021/pr060149vSuche in Google Scholar PubMed PubMed Central

44. Holst RM, Hagberg H, Wennerholm UB, Skogstrand K, Thorsen P, Jacobbson B, et al. Prediction of microbial invasion of the amniotic cavity in women with preterm labour: analysis of multiple proteins in amniotic and cervical fluids. BJOG 2011;118:240–9.10.1111/j.1471-0528.2010.02765.xSuche in Google Scholar PubMed

45. Girón de Velasco-Sada P, Falces-Romero I, Quiles-Melero I, García-Perea A, Minqorance J. Evaluation of two real time PCR assays for the detection of bacterial DNA in amniotic fluid. J Microbiol Methods 2018;144:107–10.10.1016/j.mimet.2017.11.013Suche in Google Scholar PubMed

Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2018-0306).

Received: 2018-09-14
Accepted: 2019-01-21
Published Online: 2019-02-28
Published in Print: 2019-07-26

©2019 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Preterm premature rupture of membranes (PPROM)
  4. Original Articles – Obstetrics
  5. The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis
  6. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis
  7. Maternal serum endocan concentrations are elevated in patients with preterm premature rupture of membranes
  8. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species
  9. Assessment of maternal GBS colonization and early-onset neonatal disease rate for term deliveries: a decade perspective
  10. Clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies
  11. Expression of genes involved in inflammation and growth – does sampling site in human full-term placenta matter?
  12. Impact of cell-free fetal DNA on invasive prenatal diagnostic tests in a real-world public setting
  13. Perinatal outcome in gestational diabetes according to different diagnostic criteria
  14. Original Articles – Fetus
  15. Change in fetal behavior in response to vibroacoustic stimulation
  16. Diagnostic accuracy of isolated clubfoot in twin compared to singleton gestations
  17. Original Article – Newborn
  18. Usefulness of transcutaneous bilirubin assessment measured in non-photo-exposed skin to guide the length of phototherapy: an observational study
  19. Letters to the Editor
  20. Methodological issues on the clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies
  21. Reply to the Letter to the Editor: methodological issues on the clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large-for-gestational-age (LGA) fetuses in non-diabetic pregnancies
https://doi.org/10.1515/jpm-2018-0306
Schlagwörter für diesen Artikel
amniotic fluid analysis; chorioamnionitis; clinical assessment; composite morbidity; maternal fever; maternal morbidity; maternal sepsis; neonatal morbidity; neonatal sepsis

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Preterm premature rupture of membranes (PPROM)
  4. Original Articles – Obstetrics
  5. The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis
  6. Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis
  7. Maternal serum endocan concentrations are elevated in patients with preterm premature rupture of membranes
  8. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species
  9. Assessment of maternal GBS colonization and early-onset neonatal disease rate for term deliveries: a decade perspective
  10. Clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies
  11. Expression of genes involved in inflammation and growth – does sampling site in human full-term placenta matter?
  12. Impact of cell-free fetal DNA on invasive prenatal diagnostic tests in a real-world public setting
  13. Perinatal outcome in gestational diabetes according to different diagnostic criteria
  14. Original Articles – Fetus
  15. Change in fetal behavior in response to vibroacoustic stimulation
  16. Diagnostic accuracy of isolated clubfoot in twin compared to singleton gestations
  17. Original Article – Newborn
  18. Usefulness of transcutaneous bilirubin assessment measured in non-photo-exposed skin to guide the length of phototherapy: an observational study
  19. Letters to the Editor
  20. Methodological issues on the clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies
  21. Reply to the Letter to the Editor: methodological issues on the clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large-for-gestational-age (LGA) fetuses in non-diabetic pregnancies
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