91 Utility of serial amniotic fluid analysis for intrapartum infection prediction of Triple-I: our first steps.

Abstract

The NICHD introduced suspected triple-I (intrauterine inflammation or infection) in 2015 to provide specific diagnostic recommendations for chorioamnionitis. Their criteria yielded a sensitivity and specificity of 67.6% and 38.1% for adverse infectious outcomes, respectively, with positive and negative likelihood ratios for histologically-confirmed triple-I being 1.20 and 0.70. We aim to augment the utility of triple-I definitions by examining serially-sampled amniotic fluid (AF) in laboring patients with and without suspected triple-I/Isolated Maternal Fever (IMF). This prospective cohort study enrolled term, singleton pregnancies in labor at an academic-community hospital. Patients who required an intrauterine pressure catheter (IUPC) for standard indications had AF aspirated and analyzed for: glucose, cell count, and aerobic culture at several standardized times: at IUPC placement and every 4 hours until delivery. Cohort I & II designate patients with and without triple-I/IMF, respectively. 18 patients with IUPC enrolled; 5 with triple-I/IMF and 13 who remained afebrile. Baseline AF WBC in Cohort I was 85 (IQR 58 – 144) cells/mL which increased to 222 (IQR 144 – 452) just before first fever with significant increase to 6150 (IQR 1193 – 7180)[p < 0.002] by final aspiration before delivery. In contrast, baseline AF WBC in Cohort II was 43 (IQR 19 – 70) with a nonsignificant increase to 188 (IQR 79 – 365) before delivery (Figure 1). Cohort I had a 66-fold increase from baseline to final WBC count compared to a 25-fold increase in Cohort II. AF WBC before delivery were significantly different between cohorts (p < 0.034). Remaining results in Table 1. Our preliminary results suggest that serial intrapartum AF assessment is a possible reproducible technique. Notably, there is an acute rise observed in AF WBC preceding maternal fever, suggesting this may be an early indicator of developing infection and possibly aid clinicians in antibiotic decision-making. In future studies, we aim to correlate these changes in AF parameters with maternal/newborn clinical outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)