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To evaluate amniotic fluid leukocyte esterase (LE), measured by urinalysis reagent strips, as a predictor of histologic chorioamnionitis in term pregnancies.
In this pilot study, women with singleton pregnancies at 37w0d gestation or greater undergoing cesarean delivery were recruited. Amniotic fluid was aspirated at the time of amniotomy during the cesarean and tested for LE using a urinalysis reagent strip. A LE result of at least 1+ was considered positive. All placentas were examined for histologic chorioamnionitis by a pathologist blinded to the LE results. Histologic chorioamnionitis was defined by the presence of an acute inflammatory infiltrate (neutrophils) involving the subchorionic fibrin and/or chorionic plate of the placenta or an acute inflammatory cell infiltrate involving the chorionic and/or amniotic layers of the fetal membranes. Clinical chorioamnionitis was defined as 2 or more of the following: maternal temperature 38.0 C or greater, maternal heart rate 100 bpm or greater, or fetal heart rate baseline 160 bpm or greater. Sensitivity, specificity, positive predictive value, and negative predictive values of amniotic fluid LE for histologic chorioamnionitis were calculated.
A total of 40 women were recruited, 20 with and 20 without clinical chorioamnionitis. Women without clinical chorioamnionitis underwent cesarean prior to labor or rupture of membranes while the women with clinical chorioamnionitis underwent cesarean after onset of labor or rupture of membranes. Amniotic fluid leukocyte esterase was highly predictive of histologic chorioamnionitis (Table 1).
Amniotic fluid leukocyte esterase, when measured by urinalysis reagent strips, may be highly predictive of both clinical and histologic chorioamnionitis. Further study is needed to assess the effect of labor or ruptured membranes on this potential point-of-care diagnostic and research tool.