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J. Perinat. Med. 40 (2012) 33–37 • Copyright by Walter de Gruyter • Berlin • Boston. DOI 10.1515/JPM.2011.110 2011/0144 Article in press - uncorrected proof Optimized amniotic fluid analysis in patients suspected of intrauterine infection/inflammation Catherine Ford1 and Mehmet R. Genc2,*¸ 1 Harvard School of Public Health, Boston, MA, USA 2 Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract Objective: To determine the combination of

(1.58) 0 Gestational age at presentation, week 27.90±5 25.98±4.77 0.19 Interval between presentation and delivery, day 9 (1–40) 12.5 (0.75–28.25) 0.64 Gestational age at delivery, week 31.86±6.58 28.54±3.75 0.07 Histopathological chorioamnionitis 26 (41.27) 8 (57.14) 0.27 Amniotic fluid analysis performed 40 (63.49) 3 (21.43) 0.006 Values are given as mean±standard deviation, number (percentage) or median (interquartile range), as appropriate. PPROM, preterm and prelabor rupture of membranes. AF analysis was also a strong predictor of what we defined as “justified

Ragosch et al, Prediction of RDS 351 J. Perinat. Med. 20(1992)351-360 Prediction of RDS by amniotic fluid analysis: a comparison of the prognostic value of traditional and recent methods Volker Ragosch, Sven Jürgens, Uwe Lorenz, Caroline Stolowsky, Birgit Arabin, and Hans-Karl Weitzel Department of Obstetrics and Gynecology, University Clinic, Free University of Berlin, Fed. Rep. of Germany l Introduction The chances of survival for children with respi- ratory distress syndrome (RDS) have improved markedly in the last decade, though it is still one of the major

/47), compared to 23% (7/30) in those without a cerclage (P=0.01). Perinatal outcomes according to amniotic fluid analysis and cervical cerclage Table 2 displays the perinatal outcomes according to the status of the AF and cerclage placement. Patients without IAI/I who underwent a cervical cerclage had good pregnancy outcomes. The median admission-to-delivery interval was 43 days (IQR: 15–89 days), and the median gestational age at delivery was 28 weeks (IQR: 23.7–36.3 weeks). In this group, the neonatal survival rate was 67% (26/39). There were no significant differences

–34]. The gold standard for the diagnosis of intra-amniotic infection is amniotic fluid analysis with the use of cultivation and molecular microbiologic techniques to identify the presence of bacteria [35–52] and to assess the inflammatory response [13, 35–37, 53–59]. When information about the amniotic fluid microbiology and inflammatory state is not available, pediatricians must rely on clinical risk factors (e.g., maternal fever, rupture of membranes, etc.) [26–28, 60], signs of neonatal sepsis and laboratory tests, such as neonatal white blood cell and differential

most likely explanation for this is that IL-6 is a mediator of the acute phase response, and therefore, its concentration is elevated in the presence of an inflammatory insult unrelated to infection [87, 333, 334]. For example, the maternal plasma concentration of IL-6 is elevated in patients with spontaneous labor at term [335–344] without proven infection, which was assessed by amniotic fluid analysis. In contrast to maternal plasma, amniotic fluid IL-6 concentrations are of value in the identification of the patient at risk for preterm delivery [112, 116–119, 122

Abstract

Objective: A sonographically short cervix is a powerful predictor of spontaneous preterm delivery. However, the etiology and optimal management of a patient with a short cervix in the mid-trimester of pregnancy remain uncertain. Microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation are frequently present in patients with spontaneous preterm labor or acute cervical insufficiency. This study was conducted to determine the rate of MIAC and intra-amniotic inflammation in patients with a cervical length <25 mm in the mid-trimester.

Study design: A retrospective cohort study was conducted of patients referred to our high risk clinic because of a sonographic short cervix or a history of a previous preterm birth. Amniocenteses were performed for the evaluation of MIAC and for karyotype analysis in patients with a short cervix. Fluid was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasmas. Patients with MIAC were treated with antibiotics selected by their physician.

Results: Of 152 patients with a short cervix at 14–24 weeks, 57 had amniotic fluid analysis. The prevalence of MIAC was 9% (5/57). Among these patients, the rate of preterm delivery (<32 weeks) was 40% (2/5). Microorganisms isolated from amniotic fluid included Ureaplasma urealyticum (n=4) and Fusobacterium nucleatum (n=1). Patients with a positive culture for Ureaplasma urealyticum received intravenous Azithromycin. Three patients with Ureaplasma urealyticum had a sterile amniotic fluid culture after treatment, and subsequently delivered at term. The patient with Fusobacterium nucleatum developed clinical chorioamnionitis and was induced.

Conclusion: (1) Sub-clinical MIAC was detected in 9% of patients with a sonographically short cervix (<25 mm); and (2) maternal parenteral treatment with antibiotics can eradicate MIAC caused by Ureaplasma urealyticum. This was associated with delivery at term in the three patients whose successful treatment was documented by microbiologic studies.

benefits to this subgroup are dramatic. We treated women presenting with PROM at <. 27 weeks gestation with tocolysis and prophylactic antibiotics, and electively delivered when indication of lung maturity was available on amniotic fluid analysis. Data from 18 patients with PROM at gestations <. 27 weeks were collected prospectively. The corrected perinatal survival rate (excluding 2 deaths from congenital anomalies) was 87%. The mean gestational age (GA) at rupture was 25.1 weeks (range 15.5 to 26 6 / 7 ) . One woman sealed her membranes after 10 days of therapy at 15 1

hopefully answered, by the conduct of such a trial. Put on your space suit, it’s time to blast off. After all, this isn’t rocket science – it’s more difficult. References 1. Gultekin-Elbir EE, Ford C, Genc MR. The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis. J Perinat Med 2019;47:493–9. 10.1515/jpm-2018-0306 30817305 Gultekin-Elbir EE Ford C Genc MR The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis J Perinat Med 2019 47 493 9 2. Mönckeberg M, Valdés R, Kusanovic JP, Schepeler M, Nien JK

of congenital lipoid adrenal hyperplasia (CLAH) by estriol amniotic fluid analysis and molecular genetic testing. Prenat Diag. 2008;28:11–14. 10.1002/pd.1906 Jean A Mansukhani M Oberfield SE Fennoy I Nakamoto J Atwan M Prenatal diagnosis of congenital lipoid adrenal hyperplasia (CLAH) by estriol amniotic fluid analysis and molecular genetic testing Prenat Diag 2008 28 11 14 [7] Auchus R. Chapter 3G, Genetic deficiencies of cytochrome P450c17 (CYP17A1): combined 17-hydroxylase/17,20-lyase deficiency and isolated 17,20-lyase deficiency. In: New MI, Lekarev O, Parsa A