Performance Characteristics of Putative Tests for Subclinical Chorioamnionitis

Abstract

Objective: To evaluate amniotic fluid glucose, matrix metalloproteinase (MMP)-9, interleukin (IL)-6, and IL-12 for diagnosing subclinical chorioamnionitis in women with preterm labor. Methods: Forty-four women in preterm labor at 22-35 weeks gestation with suspected subclinical chorioamnionitis underwent amniocentesis. Amniotic fluid analysis included Gram stain, culture, and determination of glucose, MMP-9, IL-6, and IL-12 concentrations. Median values of these analytes were compared using the Mann-Whitney U test. Sensitivity, specificity, and positive and negative predictive values were calculated for tests using a positive amniotic fluid culture or delivery within 24 hours as the key outcome variables. Results: Amniotic fluid concentrations of glucose, MMP-9, and IL-6 correlated closely with positive culture or delivery within 24 hours. IL-12 concentrations did not correlate with either a positive culture or delivery within 24 hours. Conclusions: Amniotic fluid glucose, MMP-9, and IL-6 reliably predict microbial invasion of the amniotic cavity or imminent delivery. IL-12 values did not correlate with amniotic fluid culture results or imminent delivery.

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

“…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.…”

Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate

“…The clinical laboratory performed the glucose and lactate dehydrogenase (LDH) measurements, the Gram's stain, the white (WBC) and red blood cell (RBC) counts. An AF glucose cut-off of Յ15 mg/dL (19) and LDH levels Ն419 U/L were considered clinically suggestive of intra-amniotic inflammation/infection (20). These results were available to the primary care providers for clinical management.…”

Soluble TLR2 Is Present in Human Amniotic Fluid and Modulates the Intraamniotic Inflammatory Response to Infection

“…A flowchart of the women enrolled in the study and subgroups of samples analyzed are presented in the supplemental Fig. 4 Amniotic fluid was retrieved from 109 women who had a clinically indicated amniocentesis in the following different populations: second trimester normal genetic karyotyping (GA median (range), 19 (15)(16)(17)(18)(19)(20)(21)(22)(23) wk, n ϭ 14), third trimester fetal lung maturity testing before cesarean delivery (GA, 37 (35)(36)(37)(38)(39) wk, n ϭ 14), and women admitted with symptoms of preterm labor who had an amniocentesis to rule out infection (GA, 28 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) wk, n ϭ 81). To avoid selection bias, women in this last group were selected from a prospective cohort of 463 consecutive patients enrolled at Yale New Haven Hospital from March 2004 to June 2008.…”

“…For all women who underwent amniocenteses to rule out infection, the clinical laboratory performed the amniotic fluid glucose and lactate dehydrogenase (LDH) measurements as well as the white blood cell count. An amniotic fluid glucose cut-off of Յ15 mg/dl, an LDH level Ն419 U/L, and/or a white blood cell count Ն100 cells/ml were considered suggestive of intraamniotic infection/inflammation (24,25,20). Concurrently, the amniotic fluid was examined in the microbiology laboratory for the presence of microorganisms using the traditional Gram staining and culturing method.…”