The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor

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Abstract

Objective

This study was undertaken to determine the clinical significance of a detection of Ureaplasma urealyticum by using the polymerase chain reaction (PCR) in the amniotic fluid of patients with preterm labor and intact membranes.

Study design

Amniocentesis was performed in 257 patients with preterm labor and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. U urealyticum was detected by PCR using specific primers. Patients were divided into 3 groups according to the results of amniotic fluid culture and PCR for U urealyticum: those with a negative culture and negative PCR (n = 228), those with a negative culture but positive PCR (n = 6), and those with a positive culture regardless of the results of PCR (n = 23).

Results

The prevalence of positive amniotic fluid culture was 9% (23 of 257). U urealyticum was detected by PCR in 6% (15 of 254) of cases. Of the 15 cases with positive PCR for U urealyticum, amniotic fluid culture was negative in 40% (6 of 15). Patients with a negative culture but positive PCR for U urealyticum had significantly shorter median amniocentesis-to-delivery interval and higher amniotic fluid interleukin-6 and white blood cell count than those with a negative amniotic fluid culture and negative PCR (P<.01 for each). Patients with a positive PCR for U urealyticum but a negative amniotic fluid culture had a higher rate of significant neonatal morbidity than those with a negative culture and negative PCR (P<.05). However, no significant differences in perinatal outcome were observed between patients with a negative culture but positive PCR and those with a positive amniotic fluid culture.

Conclusion

Patients with preterm labor and a positive PCR for U urealyticum but negative amniotic fluid culture are at risk for impending preterm delivery and adverse perinatal outcome.

Section snippets

Study population

The study population consisted of consecutive patients admitted with the diagnosis of preterm labor and intact membranes (gestational age ≤35 weeks) and singleton gestation who underwent amniocentesis for the assessment of microbiologic status of the amniotic cavity between January 1993 and July 2000. At Seoul National University Hospital, amniocentesis is routinely offered to all patients admitted with the diagnosis of preterm labor and intact membranes. Patients were divided into 3 groups

Results

The prevalence of positive amniotic fluid culture was 9% (23 of 257 cases). U urealyticum was detected by PCR assay in 6% (15 of 254) of cases with available amniotic fluid for PCR assay. Amniotic fluid for PCR assay was not available in 2 cases with a positive amniotic fluid culture for U urealyticum and 1 case with a positive culture for Burkholderia cepacia. Microorganisms isolated by culture included U urealyticum (n = 14), Enterococcus spp (n = 3), Acinetobacter spp (n = 2), Lactobacilli spp (n = 

Comment

The realization that genetic information derived from nucleic acid analysis (genotype) could be useful for the detection and identification of microorganisms has been a major conceptual advance in modern microbiology. This approach has been used for detecting the presence of microorganisms that could not be identified by culture techniques, the classification of bacteria on the basis of their evolutionary relationships, and the discovery of the causative microorganisms for several diseases such

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Supported by grant 01-PJ1-PG1-01CH07-0002 from the 2001 Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea.

Presented at the Twenty-third Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003.

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