A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery,☆☆,

https://doi.org/10.1016/S0002-9378(96)70051-0Get rights and content

Abstract

OBJECTIVE: The purpose of this study was to evaluate amniotic fluid lactate dehydrogenase level in comparison with other rapid markers in prediction of microbial invasion of the uterine cavity and preterm delivery ≤36 hours after amniocentesis. STUDY DESIGN: One hundred thirty-one women in preterm labor with intact membranes underwent transabdominal amniocentesis. Amniotic fluid was analyzed for leukocyte count, glucose level, lactate dehydrogenase level, and Gram stain. Cultures for aerobes, anaerobes, and Mycoplasma sp. were performed. Amniocentesis-to-delivery interval was calculated. The study group was divided and the findings compared according to amniotic fluid culture results and according to amniocentesis-to-delivery interval. Sensitivity, specificity, and positive and negative predictive value were calculated for lactate dehydrogenase, leukocyte count, glucose, and Gram stain in the prediction of positive amniotic fluid culture and preterm delivery 36 hours after amniocentesis. Receiver-operator characteristic curve analysis, logistic regression analysis, t tests, and nonparametric tests were used. RESULTS: The prevalence of positive amniotic fluid cultures was 12% (16 of 131). The median lactate dehydrogenase level (1084 U/L) was significantly greater for women with a positive amniotic fluid culture than for those with a negative culture (median lactate dehydrogenase level 194 U/L; p < 0.0002). The critical values calculated for optimal performance in prediction of a positive amniotic fluid culture were a lactate dehydrogenase level 419 U/L, leukocyte count 50 cells/mm3 (50 × 106/L) and glucose 17 mg/dl (0.94 mmol/L). Lactate dehydrogenase, leukocyte count, glucose, and Gram stain were equally sensitive and specific in prediction of a positive amniotic fluid culture. Thirty-nine women (29.8%) gave birth 36 hours after amniocentesis. The median lactate dehydrogenase level (414 U/L) was significantly greater among women giving birth 36 hours after amniocentesis than among women giving birth >36 hours after amniocentesis (median lactate dehydrogenase, 173 U/L; p < 0.001). Critical values of lactate dehydrogenase 225 U/L, leukocyte count 10 cells/mm3 (10 × 106/L) and glucose 34 mg/dl (1.9 mmol/L) were selected for optimal performance in prediction of amniocentesis-to-delivery interval 36 hours. Lactate dehydrogenase level had the best sensitivity (74%) in prediction of delivery 36 hours after amniocentesis in contrast to leukocyte count (49%), glucose (62%), and positive Gram stain (26%). Amniotic fluid lactate dehydrogenase values 225 U/L were associated with a fivefold greater risk for delivery 36 hours after amniocentesis (odds ratio 5.46, 95% confidence interval 2.00 to 14.87; p = 0.0006). CONCLUSION: Amniotic fluid lactate dehydrogenase level has diagnostic value in prediction of a positive amniotic fluid culture and delivery ≤36 hours after amniocentesis. Lactate dehydrogenase is a readily available, inexpensive, rapid amniotic fluid marker that can be measured in any hospital laboratory. (Am J Obstet Gynecol 1996;175:1336-41.)

Section snippets

MATERIAL AND METHODS

The study population included all patients with singleton pregnancies with the diagnosis of preterm labor and intact membranes at 23 to 35 weeks' gestation who underwent transabdominal amniocentesis at Westchester County Medical Center from Oct. 2, 1993, through June 30, 1995. Preterm labor was defined as six to eight uterine contractions in 1 hour or four in 20 minutes associated with cervical changes. Gestational ages were based on the last menstrual period or early ultrasound scans obtained

RESULTS

Of 358 women who were eligible, 138 (38.5%) agreed to participate. Seven of these women were excluded because of incomplete amniotic fluid analysis, establishing a study group of 131 women. A comparison of the group of women who chose not to participate with the study group showed no differences in maternal age, gestational age at admission, or delivery ≤36 hours after amniocentesis. The prevalence of positive amniotic fluid cultures was 12.2% (16 of 131). Table I displays the results of the

COMMENT

This study demonstrated that amniotic fluid LDH determination has diagnostic value in detecting microbial invasion of the amniotic cavity and in predicting duration of gestation after amniocentesis. In preterm labor amniotic fluid LDH level is shown to be elevated in the presence of a positive amniotic fluid culture and in patients delivering ≤36 hours after amniocentesis. Amniotic fluid LDH elevation is rarely discussed in the obstetric literature, yet in other medical fields this enzymatic

Cited by (52)

  • The combination of maternal blood and amniotic fluid biomarkers improves the predictive accuracy of histologic chorioamnionitis

    2019, Placenta
    Citation Excerpt :

    Romero et al. [21] reported that the measurement of interleukin (IL)-6 in amniotic fluid was an indicator of intrauterine infection according to amniotic fluid culture results (area under the curve, 0.927). However, amniotic fluid culture results also have high false-negative rates in the detection of intrauterine infection [20,22]. Several other reports have shown that measurement of neutrophil elastase, IL-6, IL-8, matrix metalloproteinase-9, and TNF-α in amniotic fluid are associated with HC [15,23].

  • Identification of haptoglobin switch-on status in archived placental specimens indicates antenatal exposure to inflammation and potential participation of the fetus in triggering preterm birth

    2018, Placenta
    Citation Excerpt :

    Three neonates died immediately after birth due to prematurity related complications. A diagnosis of amniotic fluid infection was established based on well recognized clinical, biochemical, and microbiological test results for glucose (cutoff ≤15 mg/dL), LDH (cutoff ≥419 U/L), WBC (cutoff ≥50 cells/μL), Gram stain, and bacterial cultures for aerobes, anaerobes, Ureaplasma and Mycoplasma species [19]. Amniotic fluid infection was considered in the presence of positive bacterial culture result and/or positive Gram stain.

  • Compartmentalization of acute phase reactants Interleukin-6, C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis

    2015, Cytokine
    Citation Excerpt :

    The clinical laboratory assessed the AF glucose, lactate dehydrogenase levels (LDH), and performed a white blood cell count (WBC). A glucose level of ⩽15 mg/dL, LDH activity ⩾419 U/L, WBC count ⩾30 cells/μL were considered indicative of IAI [13,14]. AF was concurrently examined for the presence of infection using Gram staining and culturing methods for aerobic and anaerobic bacteria, Ureaplasma, and Mycoplasma species.

View all citing articles on Scopus

From the Departments of Obstetrics and Gynecology and Pathology and the Graduate School of Health Sciences, New York Medical College, Westchester County Medical Center.

☆☆

Reprint requests: Nergesh Tejani, MD, Westchester County Medical Center, OB/GYN Department, Macy East, 2nd Floor, Valhalla, NY 10595.

0002-9378/96 $5.00 + 0 6/1/75027

View full text