Objective: We sought to identify the use of vaginal amniotic fluid (vAF) glucose measurements in predicting infection of the amniotic fluid retrieved by transabdominal amniocentesis (aAF) in women with preterm prematu...Objective: We sought to identify the use of vaginal amniotic fluid (vAF) glucose measurements in predicting infection of the amniotic fluid retrieved by transabdominal amniocentesis (aAF) in women with preterm premature rupture of the membranes (PPROM). Study design: Fluid was retrieved by aAF was retreived from 35 consecutive women with PPROM on whom an amniocentesis was clinically indicated to rule out intra- amniotic infection/inflammation and successfully completed. aAF was cultured for aerobic, anaerobic bacteria, Ureaplasma and Mycoplasma species. Clinical laboratory analysis for aAF included glucose concentration, Gram stain, lactate dehydrogenase, and white and red blood cell count. vAF was analyzed only for glucose concentration. Glucose concentration for the paired abdominal- vaginal AF samples (aAF- vAF) was determined by using well- established clinical and research laboratory methods. At the end of enrollment we stratified our patients into 2 groups: (1) positive microbial cultures (+ )AFC (n = 17, gestational age [GA]: 27.3 ± 0.7 weeks) or (2) negative microbial cultures (- )AFC (n = 18, GA: 31.3 ± 0.5 weeks). Cohen kappa measure of concordance and receiver operating characteristic (ROC) curve analysis were used to test the ability of the vaginal “ pool” glucose measurements to discriminate between women with positive or negative AF cultures. Results: Women with (+ )AFC ruptured and delivered at an earlier GA compared with the (- )AFC group (p < .001). The latency period was similar (P = .35). There was a significant linear correlation between aAF and vAF glucose concentrations (r = 0.783, P < .001). Women with intra- amniotic infection (IAI) had significantly lower aAF [mean ± SEM (+ )AFC: 11.4 ± 3.2 vs (- )AFC 23.0 ± 2.8 mg/dL, P = .01] and vAF glucose levels [(+ )AFC: 10.1 ± 2.8 vs (- )AFC: 19.8 ± 2.9 mg/dL, P = .02] compared with the noninfected group. Cohen kappa measure of concordance indicated “ substantial" agreement between aAF and vAF glucose measurements (kappa = 0.719, 95% CI = 0.491- 0.947). The sensitivity of the vAF glucose level to detect IAI ranged from 82% to 47% , whereas specificity ranged from 100% to 56% depending on the threshold we used. A vaginal “ pool" (vAF) glucose measurement less than 5 mg/dL had 47.1% sensitivity, 100% specificity, 100% positive predictive value, 66.7% negative predictive value, and 74.2% accuracy in identifying women with (+ )AFC. Conclusion: Vaginal glucose determination is a readily available, inexpensive, rapid AF marker that can be measured practically in any clinical laboratory. vAF glucosemeasurements less than 5 mg/dL have predictive value, but low sensitivity for detection of IAI.展开更多
OBJECTIVE: To compare the amniotic fluid index (AFI) with the single deepest pocket technique along with the other components of the biophysical profile (BPP) in predicting an adverse pregnancy outcome. METHODS: Prosp...OBJECTIVE: To compare the amniotic fluid index (AFI) with the single deepest pocket technique along with the other components of the biophysical profile (BPP) in predicting an adverse pregnancy outcome. METHODS: Prospective, randomized trial of amniotic fluid assessment by AFI or single deepest pocket during a BPP. Cesarean delivery for fetal distress was the primary outcome evaluated. RESULTS: The AFI was used in 273 pregnancies and the single deepest pocket in 264. The AFI significandy increased the number of pregnancies labeled as oligohydramnios, 102 women (38%) compared with 46 women (17%; P <.001), odds ratio (OR) = 2.84, 95%confidence interval 1.90-4.25 in the single deepest pocket group. There was no difference in the number of women with oligohydramnios in the AFI group, 16 of 102 (16%), undergoing a cesarean delivery for fetal intolerance of labor compared with the single deepest pocket group, 6 of 46 (13%; P = .676). More women with normal fluid by the AFI method (AFI >5), 20 of 170 (12%), underwent a cesarean delivery for fetal distress than the women with normal fluid by the single deepest pocket technique (2 cm ×1 cm pocket present) group, 12 of 218 (6%; P = .037, OR = 2.22, 95%confidence interval 1.05-4.70). CONCLUSION: The AFI offers no advantage in detecting adverse outcomes compared with the single deepest pocket when performed with the BPP. The AFI may cause more interventions by labeling twice as many at-risk pregnancies as having oligohydramnios than with the single deepest pocket technique.展开更多
文摘Objective: We sought to identify the use of vaginal amniotic fluid (vAF) glucose measurements in predicting infection of the amniotic fluid retrieved by transabdominal amniocentesis (aAF) in women with preterm premature rupture of the membranes (PPROM). Study design: Fluid was retrieved by aAF was retreived from 35 consecutive women with PPROM on whom an amniocentesis was clinically indicated to rule out intra- amniotic infection/inflammation and successfully completed. aAF was cultured for aerobic, anaerobic bacteria, Ureaplasma and Mycoplasma species. Clinical laboratory analysis for aAF included glucose concentration, Gram stain, lactate dehydrogenase, and white and red blood cell count. vAF was analyzed only for glucose concentration. Glucose concentration for the paired abdominal- vaginal AF samples (aAF- vAF) was determined by using well- established clinical and research laboratory methods. At the end of enrollment we stratified our patients into 2 groups: (1) positive microbial cultures (+ )AFC (n = 17, gestational age [GA]: 27.3 ± 0.7 weeks) or (2) negative microbial cultures (- )AFC (n = 18, GA: 31.3 ± 0.5 weeks). Cohen kappa measure of concordance and receiver operating characteristic (ROC) curve analysis were used to test the ability of the vaginal “ pool” glucose measurements to discriminate between women with positive or negative AF cultures. Results: Women with (+ )AFC ruptured and delivered at an earlier GA compared with the (- )AFC group (p < .001). The latency period was similar (P = .35). There was a significant linear correlation between aAF and vAF glucose concentrations (r = 0.783, P < .001). Women with intra- amniotic infection (IAI) had significantly lower aAF [mean ± SEM (+ )AFC: 11.4 ± 3.2 vs (- )AFC 23.0 ± 2.8 mg/dL, P = .01] and vAF glucose levels [(+ )AFC: 10.1 ± 2.8 vs (- )AFC: 19.8 ± 2.9 mg/dL, P = .02] compared with the noninfected group. Cohen kappa measure of concordance indicated “ substantial" agreement between aAF and vAF glucose measurements (kappa = 0.719, 95% CI = 0.491- 0.947). The sensitivity of the vAF glucose level to detect IAI ranged from 82% to 47% , whereas specificity ranged from 100% to 56% depending on the threshold we used. A vaginal “ pool" (vAF) glucose measurement less than 5 mg/dL had 47.1% sensitivity, 100% specificity, 100% positive predictive value, 66.7% negative predictive value, and 74.2% accuracy in identifying women with (+ )AFC. Conclusion: Vaginal glucose determination is a readily available, inexpensive, rapid AF marker that can be measured practically in any clinical laboratory. vAF glucosemeasurements less than 5 mg/dL have predictive value, but low sensitivity for detection of IAI.
文摘OBJECTIVE: To compare the amniotic fluid index (AFI) with the single deepest pocket technique along with the other components of the biophysical profile (BPP) in predicting an adverse pregnancy outcome. METHODS: Prospective, randomized trial of amniotic fluid assessment by AFI or single deepest pocket during a BPP. Cesarean delivery for fetal distress was the primary outcome evaluated. RESULTS: The AFI was used in 273 pregnancies and the single deepest pocket in 264. The AFI significandy increased the number of pregnancies labeled as oligohydramnios, 102 women (38%) compared with 46 women (17%; P <.001), odds ratio (OR) = 2.84, 95%confidence interval 1.90-4.25 in the single deepest pocket group. There was no difference in the number of women with oligohydramnios in the AFI group, 16 of 102 (16%), undergoing a cesarean delivery for fetal intolerance of labor compared with the single deepest pocket group, 6 of 46 (13%; P = .676). More women with normal fluid by the AFI method (AFI >5), 20 of 170 (12%), underwent a cesarean delivery for fetal distress than the women with normal fluid by the single deepest pocket technique (2 cm ×1 cm pocket present) group, 12 of 218 (6%; P = .037, OR = 2.22, 95%confidence interval 1.05-4.70). CONCLUSION: The AFI offers no advantage in detecting adverse outcomes compared with the single deepest pocket when performed with the BPP. The AFI may cause more interventions by labeling twice as many at-risk pregnancies as having oligohydramnios than with the single deepest pocket technique.
