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Unrecognized amnionitis and prematurity: a preliminary report

J R Bobitt, W J Ledger

    The Journal of Reproductive Medicine
    |July 1, 1977
    PubMed
    Summary
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    High amniotic fluid bacterial counts in premature labor indicate infection risk for mothers and neonates. Lower counts suggest no infectious morbidity, prompting a reevaluation of current diagnostic methods.

    Area of Science:

    • Obstetrics and Gynecology
    • Neonatology
    • Infectious Diseases

    Background:

    • Premature labor and premature rupture of membranes are significant risk factors for adverse maternal and neonatal outcomes.
    • The role of subclinical intra-amniotic infection (amnionitis) in the pathogenesis of prematurity remains incompletely understood.
    • Current diagnostic methods for intra-amniotic infection may not be sufficiently sensitive.

    Purpose of the Study:

    • To investigate the correlation between quantitative amniotic fluid bacterial counts and clinical evidence of infection in patients delivering premature infants.
    • To identify the types of bacteria commonly isolated from amniotic fluid in cases of premature labor and delivery.
    • To reevaluate the significance of unrecognized amnionitis in the context of premature labor and delivery.

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    Main Methods:

    • Quantitative amniotic fluid cultures were performed on 12 patients delivering premature infants.
    • Specimens were obtained via transcervical needle aspiration or intrauterine catheter at the time of amniotomy.
    • Clinical data, including signs of infection and maternal/neonatal morbidity, were collected and analyzed.

    Main Results:

    • Seven patients with amniotic fluid colony counts >1,000/ml had infectious morbidity in two mothers and four neonates.
    • Positive blood and cerebrospinal fluid cultures in some infants and mothers correlated with amniotic fluid isolates, including anaerobic bacteria like Bacteroides.
    • Five patients with counts <1,000/ml showed no infectious morbidity; three had no bacterial growth, and four had other prematurity-associated factors.

    Conclusions:

    • Quantitative amniotic fluid cultures can identify patients at risk for infection associated with premature delivery.
    • High bacterial loads (>1,000/ml) in amniotic fluid are strongly associated with clinical evidence of maternal and neonatal infection.
    • Current evaluation methods for premature labor and delivery may be insufficient, necessitating a reevaluation of the role of subclinical amnionitis.