Bobitt J R, Hayslip C C, Damato J D
Am J Obstet Gynecol. 1981 Aug 15;140(8):947-52. doi: 10.1016/0002-9378(81)90090-9.
The rate of microbial infection of amniotic fluid among patients in premature labor with intact membranes and the effect of this condition on perinatal morbidity and mortality are not known. Two study this question, specimens of amniotic fluid were collected by transabdominal amniocentesis from 31 patients in premature labor with intact membranes. Microorganisms were isolated from 25% (8/31) of the specimens; 87% (7/8) of these mothers underwent delivery within 48 hours of amniocentesis, and 75% (6/8) of positive culture were from mothers who were never febrile. Perinatal morbidity was significantly greater among mothers with positive amniotic fluid cultures, as evidenced by earlier gestational age at delivery (31 vs. 36 weeks), lower newborn weight (1,740 vs. 2,613 grams), and longer hospitalization (39 vs. 9 days). A few simple, commonly available laboratory tests (amniotic fluid Gram stain, lactic dehydrogenase levels, and white blood cell count) appear to be useful in making a rapid diagnosis. The data suggest that the presence of microorganisms in the amniotic fluid of afebrile patients in premature labor with intact membranes represents an infectious process rather than an innocuous condition and raises questions with regard to current obstetric trends in the management of premature labor. The routine evaluation of similar patients by transabdominal amniocentesis is not recommended unless prospective studies can demonstrate a decrease in perinatal morbidity and mortality with this approach.
胎膜完整的早产患者羊水微生物感染率以及这种情况对围产期发病率和死亡率的影响尚不清楚。为研究这个问题，通过经腹羊膜穿刺术从31例胎膜完整的早产患者中采集羊水样本。25%（8/31）的样本中分离出微生物；其中87%（7/8）的母亲在羊膜穿刺术后48小时内分娩，75%（6/8）的阳性培养结果来自从未发热的母亲。羊水培养阳性的母亲围产期发病率显著更高，表现为分娩时孕周更早（31周对36周）、新生儿体重更低（1740克对2613克）以及住院时间更长（39天对9天）。一些简单、常用的实验室检查（羊水革兰氏染色、乳酸脱氢酶水平和白细胞计数）似乎有助于快速诊断。数据表明，胎膜完整的无发热早产患者羊水中存在微生物代表一种感染过程而非无害情况，并引发了关于当前早产管理产科趋势的问题。除非前瞻性研究能证明这种方法可降低围产期发病率和死亡率，否则不建议对类似患者常规行经腹羊膜穿刺术评估。
