AMNIOTIC FLUID INFECTIONS, A PROSPECTIVE STUDY

Abstract

Fatal amniotic fluid infections were studied in a prospective analysis of 59,379 pregnancies. 31,494 well preserved placentas and approximately 60,000,000 pieces of medical, demographic, hereditary, social and postmortem data were analyzed using a log-linear model analysis of contingency tables to determine the significance of data. 386 cases were classified as amniotic fluid infections with intact membranes when acute chorioamnionitis, funisitis and inflammation of the chorionic plate were associated with acute congenital pneumonia. The fatal disorder had a frequency of 6.3/1000 live births making it the most common cause of perinatal death in the study. The disorder decreased after 27 wks gestation correlating with the appearance of antimicrobial activity in the amniotic fluid. It increased again after 37 wks when more bacteria gain access to the amniotic fluid. It was most common when gravida made few prenatal clinic visits. Many factors lost their association with the disorder when gravida made clinic visits, i.e. race, socioeconomic status, maternal age and numbers of prior pregnancies, abortions, fetal deaths and preterm deliveries. The disorder was strongly associated with gravida suboptimal weight gain suggesting that undernutrition may have a role in its genesis. The neonates had a pattern of growth retardation characteristic of undernutrition. Gravida who made few clinic visits had smaller weight gains than those who made more visits. Polyhydramnios was also correlated with the fatal disorder. (Supported by USPHS contract N01-NS-3-2311).