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

D. Garry, R. Figueroa, M. Aguero-Rosenfeld, E. Martinez, P. Visintainer, N. Tejani

Research output: Contribution to journalArticle

49 Citations (Scopus)

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 x 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 x 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.

Original languageEnglish (US)
Pages (from-to)1336-1341
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume175
Issue number5
StatePublished - 1996
Externally publishedYes

Fingerprint

Amniocentesis
Amniotic Fluid
L-Lactate Dehydrogenase
Leukocyte Count
Glucose
Hospital Laboratories
Premature Obstetric Labor
Mycoplasma
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Sensitivity and Specificity

Keywords

  • amniotic fluid
  • Lactate dehydrogenase
  • preterm delivery

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Garry, D., Figueroa, R., Aguero-Rosenfeld, M., Martinez, E., Visintainer, P., & Tejani, N. (1996). A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery. American Journal of Obstetrics and Gynecology, 175(5), 1336-1341.

A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery. / Garry, D.; Figueroa, R.; Aguero-Rosenfeld, M.; Martinez, E.; Visintainer, P.; Tejani, N.

In: American Journal of Obstetrics and Gynecology, Vol. 175, No. 5, 1996, p. 1336-1341.

Research output: Contribution to journalArticle

Garry, D, Figueroa, R, Aguero-Rosenfeld, M, Martinez, E, Visintainer, P & Tejani, N 1996, 'A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery', American Journal of Obstetrics and Gynecology, vol. 175, no. 5, pp. 1336-1341.
Garry, D. ; Figueroa, R. ; Aguero-Rosenfeld, M. ; Martinez, E. ; Visintainer, P. ; Tejani, N. / A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery. In: American Journal of Obstetrics and Gynecology. 1996 ; Vol. 175, No. 5. pp. 1336-1341.
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AU - Martinez, E.

AU - Visintainer, P.

AU - Tejani, N.

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N2 - 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 x 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 x 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.

AB - 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 x 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 x 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.

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