Asymptomatic parturient women with high-virulence bacteria in the amniotic fluid

This study describes the postpartum course of asymptomatic parturient women who had greater than or equal to 10(2) cfu of high-virulence (HV) bacteria per milliliter of amniotic fluid. Of 60 asymptomatic parturient women with greater than or equal to 10(2) cfu of HV bacteria per milliliter of amniotic fluid, 27 (48%) remained asymptomatic in the puerperium, 16 (27%) developed fever only, and 17 (28%) developed endometritis. In asymptomatic versus symptomatic women, there were no statistically significant differences in number or type of isolates or in length of membrane rupture or labor-to-collection interval. However, there were significant differences in the intervals from collection to delivery and in the rate of cesarean section delivery. For comparison, 40 of these patients were matched with women in whom only low-virulence organisms were detected in the amniotic fluid. In the HV group, 16 women (40%) remained asymptomatic, 15 (37.5%) developed fever only, and nine (22.5%) had endometritis. In the low-virulence group, 27 women (67.5%) remained asymptomatic, 10 (25%) developed fever only, one (2.5%) developed endometritis 10 days post partum, and two (5%) had other infections (p less than 0.01). Clinically evident uterine infection depends upon type and numbers of bacteria in utero, duration of bacteria in utero, and route of delivery.