Comparison of gram stain, leukocyte esterase activity, and amniotic fluid glucose concentration in predicting amniotic fluid culture results in preterm premature rupture of membranes.
OBJECTIVE
The purpose of this study was to prospectively compare three rapid and inexpensive tests that have been proposed as predictors of amniotic fluid culture results in preterm premature rupture of membranes.


METHODS
Amniocentesis was performed on 117 patients < or = 34 weeks' gestational age with premature rupture of membranes and no clinical evidence of infection. Amniotic fluid was sent for Gram stain and aerobic, anaerobic, and Mycoplasma cultures. Leukocyte esterase activity and glucose concentration were also determined on the amniotic fluid.


RESULTS
Amniotic fluid cultures were positive in 56 patients (47.8%). Leukocyte esterase activity of 1+ or 2+ and an amniotic fluid glucose concentration < or = 16 mg/dl were significantly more sensitive (p < 0.005) than Gram stain in detecting positive amniotic fluid cultures (73%, 68%, and 41%, respectively).


CONCLUSIONS
Although each of these rapid tests is useful in assessing for subclinical intraamniotic infection, none of them have sufficient accuracy to make clinical decisions solely on the basis of their results.
Gauthier
D W
DW
Department of Obstetrics and Gynecology, University of Illinois, Chicago.
Meyer
W J
WJ
D000653:Amniotic Fluid / Q000378:metabolism / Q000382:microbiology*; D004950:Esterases / Q000378:metabolism*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology*; D005544:Forecasting; D005840:Gentian Violet; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007962:Leukocytes / Q000201:enzymology*; D009994:Osmolar Concentration; D010619:Phenazines; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
C035863:Gram's stain; D010619:Phenazines; D004950:Esterases; D005947:Glucose; D005840:Gentian Violet