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. 1994;1(4):166–172. doi: 10.1155/S1064744994000025

Amniotic Fluid Glucose Concentration: A Marker for Infection in Preterm Labor and Preterm Premature Rupture of Membranes

Gary A Dildy 1,2,✉, Mark D Pearlman 1, Leon G Smith 1, Guillermo Tortolero-Luna 1, Sebastian Faro 1, David B Cotton 1
PMCID: PMC2364340  PMID: 18475339

Abstract

Amniotic fluid Gram stain and culture have been utilized as laboratory tests of microbial invasion of the amniotic cavity. The Gram stain of amniotic fluid has a low sensitivity in the detection of clinical infection or microbial invasion of the amniotic cavity, and amniotic fluid culture results are not immediately available for management decisions. Glucose concentration is used to diagnose infection in other sites such as cerebrospinal fluid.

Objective: The purpose of this study was to evaluate the usefulness of amniotic fluid glucose concentration in detecting microbial invasion of the amniotic cavity associated with preterm labor and preterm premature rupture of membranes.

Methods: Amniocentesis was performed in 60 women with preterm labor and/or preterm premature rupture of membranes. Gram stain and culture for Mycoplasma hominis, Ureaplasma urealyticum, aerobic, and anaerobic bacteria were performed. Subjects were studied prospectively for the development of positive amniotic fluid cultures and the development of clinical chorioamnionitis.

Results: The diagnosis of clinical chorioamnionitis was made in 25% (15/60) of women entered into the study. Low amniotic fluid glucose concentration Was considered < 15 mg/dl. The sensitivity, specificity, and positive predictive value of low amniotic, fluid glucose concentration to predict clinical chorioamnionitis were 73.3%, 88.1%, and 68.8% respectively, while positive amniotic fluid culture, hada sensitivity of 43.8%, specificity of 79.5%, and positive predictive value of 43.8%.

Conclusions: Amniotic fluid glucose concentration was more sensitive in predicting chorioamnionitis than either Gram stain or culture. Amniotic fluid glucose concentration was better in predicting clinical chorioamnionitis than predicting positive amniotic fluid culture results. Gestational age-dependent normal ranges and pathologic conditions that may alter amniotic fluid glucose concentrations should be considered when interpreting amniotic fluid glucose values to diagnose microbial invasion of the amniotic cavity.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bobitt J. R., Hayslip C. C., Damato J. D. Amniotic fluid infection as determined by transabdominal amniocentesis in patients with intact membranes in premature labor. Am J Obstet Gynecol. 1981 Aug 15;140(8):947–952. doi: 10.1016/0002-9378(81)90090-9. [DOI] [PubMed] [Google Scholar]
  2. Bratlid D., Lindback T. Bacteriolytic activity of amniotic fluid. Obstet Gynecol. 1978 Jan;51(1):63–66. [PubMed] [Google Scholar]
  3. Bretz G., Mauer A. M. Glucose consumption by polymorphonuclear leukocytes in the cerebrospinal fluid of patients with bacterial meningitis. J Pediatr. 1967 May;70(5):767–771. doi: 10.1016/s0022-3476(67)80328-7. [DOI] [PubMed] [Google Scholar]
  4. Drazancić A., Kuvacić I. Amniotic fluid glucose concentration. Am J Obstet Gynecol. 1974 Sep;120(1):40–48. [PubMed] [Google Scholar]
  5. GOLDRING S., HARFORD C. G. Effect of leucocytes and bacteria on glucose content of the cerebrospinal fluid in meningitis. Proc Soc Exp Biol Med. 1950 Dec;75(3):669–672. doi: 10.3181/00379727-75-18300. [DOI] [PubMed] [Google Scholar]
  6. Garite T. J., Freeman R. K. Chorioamnionitis in the preterm gestation. Obstet Gynecol. 1982 May;59(5):539–545. [PubMed] [Google Scholar]
  7. Gauthier D. W., Meyer W. J., Bieniarz A. Correlation of amniotic fluid glucose concentration and intraamniotic infection in patients with preterm labor or premature rupture of membranes. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1105–1110. doi: 10.1016/0002-9378(91)90480-f. [DOI] [PubMed] [Google Scholar]
  8. Gibbs R. S., Castillo M. S., Rodgers P. J. Management of acute chorioamnionitis. Am J Obstet Gynecol. 1980 Mar 15;136(6):709–713. doi: 10.1016/0002-9378(80)90445-7. [DOI] [PubMed] [Google Scholar]
  9. Kiltz R. J., Burke M. S., Porreco R. P. Amniotic fluid glucose concentration as a marker for intra-amniotic infection. Obstet Gynecol. 1991 Oct;78(4):619–622. [PubMed] [Google Scholar]
  10. Kirshon B., Rosenfeld B., Mari G., Belfort M. Amniotic fluid glucose and intraamniotic infection. Am J Obstet Gynecol. 1991 Mar;164(3):818–820. doi: 10.1016/0002-9378(91)90522-s. [DOI] [PubMed] [Google Scholar]
  11. Miller J. M., Jr, Hill G. B., Welt S. I., Pupkin M. J. Bacterial colonization of amniotic fluid in the presence of ruptured membranes. Am J Obstet Gynecol. 1980 Jun 15;137(4):451–458. doi: 10.1016/0002-9378(80)91126-6. [DOI] [PubMed] [Google Scholar]
  12. PETERSDORF R. G., GARCIA M., SWARNER D. R. Mechanism of hypoglycorrhachia in experimental pneumococcal meningitis. Proc Soc Exp Biol Med. 1959 Oct-Dec;102:669–672. doi: 10.3181/00379727-102-25356. [DOI] [PubMed] [Google Scholar]
  13. PETERSDORF R. G., SWARNER D. R., GARCIA M. Synergistic action of pneumococci and leukocytes in lowering cerebrospinal fluid glucose. Proc Soc Exp Biol Med. 1960 Feb;103:380–382. doi: 10.3181/00379727-103-25527. [DOI] [PubMed] [Google Scholar]
  14. Romero R., Emamian M., Quintero R., Wan M., Hobbins J. C., Mazor M., Edberg S. The value and limitations of the Gram stain examination in the diagnosis of intraamniotic infection. Am J Obstet Gynecol. 1988 Jul;159(1):114–119. doi: 10.1016/0002-9378(88)90503-0. [DOI] [PubMed] [Google Scholar]
  15. Romero R., Jimenez C., Lohda A. K., Nores J., Hanaoka S., Avila C., Callahan R., Mazor M., Hobbins J. C., Diamond M. P. Amniotic fluid glucose concentration: a rapid and simple method for the detection of intraamniotic infection in preterm labor. Am J Obstet Gynecol. 1990 Sep;163(3):968–974. doi: 10.1016/0002-9378(90)91106-m. [DOI] [PubMed] [Google Scholar]
  16. Spellacy W. N., Buhi W. C., Bradley B., Holsinger K. K. Maternal, fetal and amniotic fluid levels of glucose, insulin and growth hormone. Obstet Gynecol. 1973 Mar;41(3):323–331. [PubMed] [Google Scholar]
  17. WILLIAMS R. D. ALTERATIONS IN THE GLUCOSE TRANSPORT MECHANISM IN PATIENTS WITH COMPLICATIONS OF BACTERIAL MENINGITIS. Pediatrics. 1964 Oct;34:491–502. [PubMed] [Google Scholar]
  18. Weiss P. A., Hofmann H., Winter R., Pürstner P., Lichtenegger W. Amniotic fluid glucose values in normal and abnormal pregnancies. Obstet Gynecol. 1985 Mar;65(3):333–339. [PubMed] [Google Scholar]
  19. Zlatnik F. J., Cruikshank D. P., Petzold C. R., Galask R. P. Amniocentesis in the identification of inapparent infection in preterm patients with premature rupture of the membranes. J Reprod Med. 1984 Sep;29(9):656–660. [PubMed] [Google Scholar]

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