Unrecognized amnionitis and prematurity: a preliminary report.

Quantitative amniotic fluid cultures were performed on 12 patients delivered of premature infants (10-premature labor, 2-premature rupture of membranes). Specimens from patients in premature labor were obtained at the time of amniotomy via transcervical needle aspiration or intrauterine catheter. Of the seven patients with colony counts greater than 1,000 per ml, two mothers and four neonates had clinical evidence of infection. Blood cultures from two infants and one mother and cerebrospinal fluid cultures from one newborn infant were positive for the same organism isolated from amniotic fluid. Anearobic bacteria were the predominant isolates in four specimens and included Bacteriodes species in two. In contrast, the five mothers and infants associated with counts of less than 1,000 per ml exhibited no infectious morbidity. Three had no bacterial growth from amniotic fluid, and factors commonly associated with prematurity were recognized in four. These clinical and microbiologic observations suggest that current methods of evaluating patients with premature labor and delivery are incomplete, and the role of unrecognized amnionitis should be reevaluated.