The value of the leukocyte esterase test in diagnosing intra-amniotic infection.
This communication examines the diagnostic value of the leukocyte esterase activity (LEA) test in the detection of intra-amniotic infection. Amniotic fluid from 171 consecutive patients with premature rupture of membranes (n = 149) and preterm labor (n = 22) was obtained through amniocentesis. Gram stain, bacterial and mycoplasma cultures, and LEA tests were performed. The LEA had a sensitivity of 19%, a specificity of 86.7%, a positive predictive value (PPV) of 42.3% and a negative predictive value (NPV) of 67.6% in the prediction of a positive amniotic fluid culture (prevalence of positive cultures = 33.9%). The Gram stain had a sensitivity of 36.2%, specificity of 94.7%, PPV of 77.8%, and NPV of 74.3%. When both tests were combined, a significant increase in sensitivity to 50% was observed. This was associated with a drop in specificity to 81.4%. There was a correlation between the number of white blood cells in the amniotic fluid and the result of the LEA test. A positive LEA assay was associated with an increased likelihood of postpartum endometritis, but not with clinical chorioamnionitis or neonatal infectious morbidity.
Romero
R
R
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510.
Emamian
M
M
Wan
M
M
Yarkoni
S
S
McCormack
W
W
Mazor
M
M
Hobbins
J C
JC
D000649:Amniocentesis; D000653:Amniotic Fluid / Q000166:cytology* / Q000382:microbiology; D002821:Chorioamnionitis / Q000175:diagnosis / Q000382:microbiology; D004796:Clinical Enzyme Tests; D004716:Endometritis / Q000175:diagnosis / Q000382:microbiology; D004950:Esterases / Q000097:blood*; D005069:Evaluation Studies as Topic; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D007962:Leukocytes / Q000201:enzymology*; D007752:Obstetric Labor, Premature / Q000175:diagnosis / Q000382:microbiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000382:microbiology; D011645:Puerperal Infection / Q000175:diagnosis / Q000382:microbiology
D004950:Esterases