Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection?

被引:80
作者
Romero, Roberto [1 ,2 ,3 ,4 ,5 ,6 ]
Chaemsaithong, Piya [2 ,3 ,5 ,7 ]
Korzeniewski, Steven J. [2 ,3 ,5 ,7 ]
Kusanovic, Juan P. [2 ,3 ,7 ,8 ,9 ]
Docheva, Nikolina [2 ,3 ,5 ,7 ]
Martinez-Varea, Alicia [2 ,3 ,5 ,7 ]
Ahmed, Ahmed I. [2 ,3 ,5 ,7 ]
Yoon, Bo Hyun [10 ]
Hassan, Sonia S. [2 ,3 ,5 ,7 ]
Chaiworapongsa, Tinnakorn [2 ,3 ,5 ,7 ]
Yeo, Lami [2 ,3 ,5 ,7 ]
机构
[1] Wayne State Univ, Hutzel Womens Hosp, Perinatol Res Branch, NICHD,NIH,DHHS, Detroit, MI 48201 USA
[2] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Perinatol Res Branch, Program Perinatal Res & Obstet, Div Intramural Res,NIH, Bethesda, MD USA
[3] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Perinatol Res Branch, Program Perinatal Res & Obstet, Div Intramural Res,NIH, Detroit, MI USA
[4] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA
[5] Michigan State Univ, Dept Epidemiol & Biostat, E Lansing, MI 48824 USA
[6] Wayne State Univ, Dept Mol Obstet & Genet, Detroit, MI 48201 USA
[7] Wayne State Univ, Sch Med, Dept Obstet & Gynecol, Detroit, MI 48201 USA
[8] Hosp Dr Sotero del Rio, Ctr Res & Innovat Maternal Fetal Med CIMAF, Santiago, Chile
[9] Pontificia Univ Catolica Chile, Dept Obstet & Gynecol, Santiago, Chile
[10] Seoul Natl Univ, Coll Med, Dept Obstet & Gynecol, Seoul, South Korea
关键词
Amniocentesis; fever; foul-smelling amniotic fluid; funisitis; histological chorioamnionitis; intra-amniotic inflammation; maternal leukocytosis; preterm birth; sterile inflammation; tachycardia; uterine tenderness; AMNIOTIC-FLUID INFECTION; NEONATAL SEPSIS EVALUATION; PRETERM PREMATURE RUPTURE; EPIDURAL LABOR ANALGESIA; MICROBIAL INVASION; RANDOMIZED-TRIAL; GUT MICROBIOTA; HISTOLOGIC CHORIOAMNIONITIS; ANTIBIOTIC EXPOSURE; CESAREAN DELIVERY;
D O I
10.1515/jpm-2015-0044
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: The diagnosis of clinical chorioamnionitis is based on a combination of signs [fever, maternal or fetal tachycardia, foul-smelling amniotic fluid (AF), uterine tenderness and maternal leukocytosis]. Bacterial infections within the amniotic cavity are considered the most frequent cause of clinical chorioamnionitis and an indication for antibiotic administration to reduce maternal and neonatal morbidity. Recent studies show that only 54% of patients with the diagnosis of clinical chorioamnionitis at term have bacteria in the AF and evidence of intra-amniotic inflammation. The objective of this study was to examine the performance of the clinical criteria for the diagnosis of chorioamnionitis to identify patients with microbial-associated intra-amniotic inflammation (also termed intra-amniotic infection). Materials and methods: This retrospective cross-sectional study included 45 patients with the diagnosis of clinical chorioamnionitis at term, whose AF underwent analysis for: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad primers], and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay. The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of each clinical sign and their combination to identify clinical chorioamnionitis were determined using microbial-associated intra-amniotic inflammation [presence of microorganisms in the AF using cultivation or molecular techniques and elevated AF IL-6 concentrations (>= 2.6 ng/mL)] as the gold standard. Results: The accuracy of each clinical sign for the identification of microbial-associated intra-amniotic inflammation (intra-amniotic infection) ranged between 46.7% and 57.8%. The combination of fever with three or more clinical criteria did not substantially improve diagnostic accuracy. Conclusion: In the presence of a fever during labor at term, signs used to diagnose clinical chorioamnionitis do not accurately identify the patient with proven intra-amniotic infection (i.e., those with microorganisms detected by culture or molecular microbiologic techniques and an associated intra-amniotic inflammatory response).
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页码:23 / 32
页数:10
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