Amniotic fluid leukocytes and leukocyte esterase activity in parturients delivered by caesarean section

Amniotic fluid specimens from parturients undergoing caesarean delivery were examined for leukocytes and leukocyte esterase activity, as well as for amniotic fluid bacteria and mycoplasmas by cultivation. The aim of this study was to evaluate the intrauterine environment in noninfected parturients and the associations between leukocyte test results, amniotic fluid microbial colonization and postcaesarean endometritis. Samples were obtained by direct aspiration at operation from 289 parturients with no clinical intrauterine infection. Among the total study population, leukocytes were found in 41% of the amniotic fluid samples by Gram staining and in 39% of the samples by the leukocyte esterase activity test. Leukocytes and leukocyte esterase activity were observed significantly more often in the amniotic fluids of parturients undergoing operation after onset of labour or ruptured membranes compared with those operated upon with intact membranes and no labour (p < 0.0001 and p < 0.0001). Of 255 amniotic fluid cultures, microbial colonization was observed in 82 (32%) parturients. Positive results in the leukocyte tests were associated significantly with amniotic fluid microbial colonization among parturients who underwent operation with intact membranes, or who underwent operation after rupture of the membranes and had cervical dilatation of < 5 cm at the operation (Gram stain: p < 0.0001; leukocyte esterase: p < 0.003). If cervical dilatation was > or = 5 cm, no such association was observed. In the population studied, endometritis developed in 2% and 4% of the parturients with positive test results. Thus, neither the presence of leukocytes nor detected leukocyte esterase activity were predictive of subsequent postoperative endometritis. In the detection of amniotic fluid microbial colonization, the tests functioned best in non-laboring parturients with intact membranes and in those operated on at the early stage of labour.