Duff P, Gibbs R S, St Clair P J, Weinberg L C
Obstet Gynecol. 1984 Jun;63(6):781-6.
The objective of this investigation was to develop a rapid diagnostic test to identify patients at exceptionally high risk for postcesarean endomyometritis. Intraoperative samples of endometrium, chorioamniotic membrane, and amniotic fluid were obtained from 70 patients undergoing nonelective cesarean section and were processed for bacterial culture, Gram stain, and histologic examination. Endomyometritis occurred in 57% of patients. Women with positive bacterial cultures (growth of high virulence organisms on the primary plates), positive Gram stains (bacteria in any oil immersion field), and histologic evidence of leukocytic infiltration in the chorioamniotic membrane and endometrium (greater than or equal to ten white blood cells per high-power field) were more likely than were patients with negative findings to develop endomyometritis. All of the laboratory tests evaluated were specific but insensitive predictors of infection. Assessment of duration of ruptured membranes and length of labor provided a diagnostic test that was as clinically useful in predicting postoperative infection as were any of the laboratory studies evaluated.
本研究的目的是开发一种快速诊断试验，以识别剖宫产术后发生子宫内膜炎风险极高的患者。从70例行非选择性剖宫产的患者中获取术中子宫内膜、绒毛羊膜和羊水样本，进行细菌培养、革兰氏染色和组织学检查。57%的患者发生了子宫内膜炎。细菌培养阳性（初代平板上生长高毒力微生物）、革兰氏染色阳性（任何油镜视野下有细菌）以及绒毛羊膜和子宫内膜有白细胞浸润的组织学证据（每高倍视野大于或等于10个白细胞）的女性比检查结果为阴性的患者更易发生子宫内膜炎。所评估的所有实验室检查都是感染的特异性但不敏感的预测指标。评估胎膜破裂时间和产程时长所提供的诊断试验在预测术后感染方面与所评估的任何实验室检查一样具有临床实用性。
