Cervical insufficiency, amniotic fluid sludge, intra-amniotic infection, and maternal bacteremia: the need for a point-of-care test to assess inflammation and bacteria in amniotic fluid. (17th December 2022)

• Record Type: Journal Article
• Authors: Jung, Eun Jung; Romero, Roberto; Gomez-Lopez, Nardhy; Paredes, Carmen; Diaz-Primera, Ramiro; Hernandez-Andrade, Edgar; Hsu, Chaur-Dong; Yeo, Lami
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 35:Number 24(2022)
• Page Start: 4775
• Page End: 4781
• Publication Date: 2022-12-17
• Subjects: Histological chorioamnionitis -- intra-amniotic infection -- intra-amniotic inflammation -- microbial biofilm -- preterm delivery -- preterm prelabor rupture of membranes; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2020.1863369
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Acute cervical insufficiency is frequently associated with subclinical intra-amniotic inflammation and intra-amniotic infection. Amniotic fluid analysis has been recommended prior to the placement of a cervical cerclage given that preexisting infection is associated with adverse pregnancy outcome. We report a case for which commonly available laboratory tests—amniotic fluid Gram stain, white blood cell count, and glucose concentration—did not detect either intra-amniotic inflammation, diagnosed by elevated amniotic fluid interleukin-6, or intra-amniotic infection, diagnosed by cultivation. Following cerclage placement, the patient developed clinical chorioamnionitis and bacteremia and experienced a spontaneous mid-trimester pregnancy loss. This case illustrates the need for a rapid and sensitive point-of-care test capable of detecting infection or inflammation, given recent evidence in support of treatment of intra-amniotic infection and intra-amniotic inflammation with antimicrobial agents.