LOW AMNIOTIC-FLUID GLUCOSE-LEVELS ARE A SPECIFIC BUT NOT A SENSITIVE MARKER FOR SUBCLINICAL INTRAUTERINE INFECTIONS IN PATIENTS IN PRETERM LABOR WITH INTACT MEMBRANES

OBJECTIVE: The purpose of this study was to evaluate the ability of a low amniotic fluid glucose level, as defined by previously published thresholds, to identify a subclinical intrauterine infection in women in preterm labor with intact membranes. STUDY DESIGN: Amniotic fluid glucose levels, amniotic fluid cultures, and placental histologic characteristics were determined in women with preterm labor (n = 55) and in preterm controls (n = 58). These amniotic fluid glucose levels were compared between women with and without intrauterine infection using the Mann-Whitney U test. The sensitivity, specificity, and positive and negative predictive values for the identification of an intrauterine infection were determined with four different previously published amniotic fluid glucose threshold levels and the threshold from receiver-operator characteristic curve analysis of the study data. RESULTS: The median amniotic fluid glucose level was significantly lower in patients with positive amniotic fluid cultures (intraamniotic infection group) but was not lower in the group of patients with only histologic chorioamnionitis (extraamniotic infection group), compared with noninfected controls. The sensitivity of a low amniotic fluid glucose level to detect both types of intrauterine infection ranged from 41% to 55%, depending on the threshold used. The specificity of a low amniotic fluid glucose level to detect an intrauterine infection ranged from 94% to 100%, the positive predictive value ranged from 86% to 100%, and the negative predictive value ranged from 70% to 80% with the same thresholds. CONCLUSION: Low amniotic fluid glucose levels are a specific but not a sensitive marker for either intraamniotic or extraamniotic intrauterine infections in patients with preterm labor.