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Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
A dipstick test for infection in preterm premature rupture of the membranes
1Department of Obstetrics and Gynecology, King George V Hospital, Royal Prince Alfred Hospital, Sydney, Australia.
Abstract:
Microbiological analysis of amniotic fluid obtained by amniocentesis is increasingly employed in preterm premature rupture of the membranes (PPROM) to predict those patients at increased risk of chorioamnionitis. Although liquor culture appears the most accurate predictor, a role exists for rapid but slightly less accurate testing. In this study, a dipstick (Cytur-test) which predicts the presence of leukocytes was evaluated in amniotic fluid. Twenty-one samples were obtained by amniocentesis from 25 women with PPROM at gestation 26-34 weeks. The dipstick predicted 5 out of 6 specimens with a positive culture and 12 of 14 with a negative culture (figure 1). Its accuracy as a predictor of a positive culture was similar to microscopy for polymorphs, with sensitivities of 83.3% and 80% respectively and specificities of 85.7% and 92.3%. Neither test proved as predictive of histological chorioamnionitis due to 6 patients delivering greater than 48 hours after amniocentesis who may have developed infection subsequent to the demonstration of sterile liquor.
Insights
A dipstick test accurately predicts infection in preterm premature rupture of the membranes (PPROM) cases. This rapid test aids in identifying chorioamnionitis risk when amniotic fluid analysis is needed.
Area of Science:
- Obstetrics and Gynecology
- Clinical Microbiology
- Perinatal Medicine
Background:
- Microbiological analysis of amniotic fluid aids in predicting chorioamnionitis risk in preterm premature rupture of the membranes (PPROM).
- While liquor culture is highly accurate, rapid testing methods are being explored for clinical utility.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a leukocyte dipstick test (Cytur-test) for detecting infection in amniotic fluid from women with PPROM.
Main Methods:
- Amniotic fluid samples were collected via amniocentesis from 25 women with PPROM (gestation 26-34 weeks).
- The Cytur-test's performance was compared against microbiological culture results.
- Sensitivity and specificity were calculated for the dipstick test and microscopy for polymorphs.
Main Results:
- The dipstick test correctly identified 5/6 positive cultures and 12/14 negative cultures.
- Sensitivity was 83.3% and specificity was 85.7% for the dipstick test.
- Performance was comparable to microscopy for polymorphs, suggesting its utility as a rapid predictor.
Conclusions:
- The Cytur-test demonstrates significant accuracy in predicting positive amniotic fluid cultures in PPROM.
- This rapid dipstick test offers a valuable alternative or adjunct to traditional methods for identifying infection risk.
- Further studies are needed to assess its predictive value for histological chorioamnionitis, considering potential post-procedure infections.
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