Chorioamnionitis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
Diagnostic Study of Choice
Study of choice
There is no single diagnostic study of choice for the diagnosis of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, laboratory findings, and/or histopathologic evaluation.[1]
- The microbiological culture of the amniotic fluid is the gold standard (test) for the diagnosis of chorioamnionitis. However, the disadvantage of this diagnostic study is the invasive nature of the test and potential side effects.
- The diagnosis of clinical chorioamnionitis is solely based on clinical features, which include maternal fever > 100.4 F and at least two of the following clinical findings:
- Uterine tenderness
- Maternal/fetal tachycardia
- Foul-smelling/purulent amniotic fluid
The comparison of various clinical features for the diagnosis of chorioamnionitis
Although the sensitivity of clinical findings for chorioamnionitis is very high (i.e., maternal fever with 95% sensitivity), their specificities are low. Measurement of accuracy is based on both sensitivity and specificity.[2]
| Findings | Accuracy |
|---|---|
| Maternal fever | 30% |
| Maternal tachycardia | 51.1% |
| Fetal tachycardia | 57.8% |
| Maternal leukocytosis | 55.6% |
| Uterine tenderness | 48.9% |
| Malodorous amniotic fluid | 46.7% |
The comparison of various amniotic fluid parameter for the diagnosis of chorioamnionitis
The sensitivity and specificity of amniotic fluid parameters for the diagnosis of chorioamnionitis are indicated in the table below.[1]
| Test | Sensitivity | Specificity |
|---|---|---|
| Culture (Amniotic fluid) | Gold | standard |
| Gram stain (Amniotic fluid) | 24% | 99% |
| Glucose level (Amniotic fluid) | 57% | 74% |
| IL-6 (Amniotic fluid) | 81% | 75% |
| Matrix metalloproteinase (Amniotic fluid) | 90% | 80% |
| White blood cell count (Amniotic fluid) | 57% | 78% |
| Leukocyte esterase (Amniotic fluid) | 85%-91% | 95%-100% |
References
- ↑ 1.0 1.1 Tita AT, Andrews WW (June 2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
- ↑ Burke C, Chin EG (2016). "Chorioamnionitis at Term: Definition, Diagnosis, and Implications for Practice". J Perinat Neonatal Nurs. 30 (2): 106–14. doi:10.1097/JPN.0000000000000163. PMID 27104601.