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[Glucose determination as prognosis index of intra-amniotic infection]
H H Bustos Lopez1, J Luis Arredondo, C Villanueva Diaz
1Departamento de Bioquímica e Infectología e Inmunología Perinatal, Instituto Nacional de Perinatología, México, D.F.
Abstract:
Intraamniotic infection is a frequent problem in Obstetrics, and is related with an important maternal and fetal impact, being important pre-term delivery and premature rupture of membranes. The "golden" test for this entity is bacteriological culture. Its use is limited in function of time (more than two days) and disponibility. The rapid diagnosis of infection in vital to start antimicrobial management and evaluation of uterine evacuation. Low concentrations of glucose (G) have been used as prognostic of infection in different biological compartments. The objective of this study is to evaluate the usefulness of G as prognostic index of intraamniotic infection (PIIAI) as compared with Gram tincture (GT) and bacteriological culture. Sixty four patients were included. Group I (n = 33) with infection, and group II (n = 31) without infection. Average of G for group I was 19.96 +/- 07.61 ES and 114.46 +/- 20.09 ES for the group II, with p less than 0.001. The sensitivity (S), specificity (Sp), positive predictive value (+PV) and negative (-PV) for a concentration of G in amniotic fluid less than 15 mg/dl was 72, 77, 77 and 72% respectively. The S, Sp +PV and -PV for G minor than 10 mg/dl was 69, 87, 85 and 73%. Gram tinction had a S, Sp +PV and -PV of 57, 83, 79, 65%. If both determinations are put together (G and GT), one sees and S of 88%, Sp 77% +PV 80% and -PV 85%.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Low amniotic fluid glucose levels can help rapidly diagnose intraamniotic infection, improving patient outcomes. This study shows glucose testing combined with Gram stain is a valuable prognostic tool for obstetric infections.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Intraamniotic infection is a common obstetric complication with significant maternal and fetal implications.
- Current diagnostic methods like bacteriological culture are time-consuming (over 48 hours) and not always readily available.
- Rapid diagnosis is crucial for timely antimicrobial treatment and management of uterine evacuation.
Purpose of the Study:
- To evaluate the utility of amniotic fluid glucose concentration as a prognostic index for intraamniotic infection (PIIAI).
- To compare the diagnostic performance of glucose levels with Gram stain (GT) and bacteriological culture.
- To assess the combined diagnostic value of glucose levels and Gram stain.
Main Methods:
- A study involving 64 patients, divided into Group I (n=33) with infection and Group II (n=31) without infection.
- Measurement of amniotic fluid glucose (G) concentrations.
- Comparison of glucose levels, Gram stain, and bacteriological culture for diagnosing intraamniotic infection.
Main Results:
- Significantly lower average glucose levels were observed in infected patients (19.96 ± 7.61 mg/dL) compared to non-infected patients (114.46 ± 20.09 mg/dL) (p < 0.001).
- For glucose < 15 mg/dL, sensitivity was 72%, specificity 77%, positive predictive value (PV+) 77%, and negative PV (PV-) 72%.
- For glucose < 10 mg/dL, sensitivity was 69%, specificity 87%, PV+ 85%, and PV- 73%. Gram stain showed 57% sensitivity, 83% specificity, 79% PV+, and 65% PV-.
- Combining glucose levels and Gram stain yielded 88% sensitivity, 77% specificity, 80% PV+, and 85% PV-.
Conclusions:
- Amniotic fluid glucose concentration is a useful prognostic index for intraamniotic infection.
- Combining glucose testing with Gram stain significantly improves diagnostic accuracy for intraamniotic infection compared to either method alone.
- This combined approach offers a rapid and effective diagnostic strategy in obstetric practice.