A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery

OBJECTIVE: The purpose of this study was to evaluate amniotic fluid lactate dehydrogenase level in comparison with other rapid markers in prediction of microbial invasion of the uterine cavity and preterm delivery less than or equal to 36 hours after amniocentesis. STUDY DESIGN: One hundred thirty-one women in preterm labor with intact membranes underwent transabdominal amniocentesis. Amniotic fluid was analyzed for leukocyte count, glucose level, lactate dehydrogenase level, and Gram stain. Cultures for aerobes, anaerobes, and Mycoplasma sp, were performed. Amniocentesis-to-delivery interval was calculated. The study group was divided and the findings compared according to amniotic fluid culture results and according to amniocentesis-to-delivery interval. Sensitivity, specificity and positive and negative predictive value were calculated for lactate dehydrogenase, leukocyte count, glucose, and Gram stain in the prediction of positive amniotic fluid culture and preterm delivery less than or equal to 36 hours after amniocentesis. Receiver-operator characteristic curve analysis, logistic regression analysis, t tests, and nonparametric tests were used. RESULTS: The prevalence of positive amniotic fluid cultures was 12% (16 of 131). The median lactate dehydrogenase level (1084 U/L) was significantly greater for women with a positive amniotic fluid culture than for those with a negative culture (median lactate dehydrogenase level 194 U/L; p < 0.0002). The critical values calculated for optimal performance in prediction of a positive amniotic fluid culture were a lactate dehydrogenase level greater than or equal to 419 U/L, leukocyte count greater than or equal to 50 cells/mm(3) (50 x 10(6)/L) and glucose less than or equal to 17 mg/dl (0.94 mmol/L). Lactate dehydrogenase, leukocyte count, glucose, and Gram stain were equally sensitive and specific in prediction of a positive amniotic fluid culture. Thirty-nine women (29.8%) gave birth less than or equal to 36 hours after amniocentesis. The median lactate dehydrogenase level (414 U/L) was significantly greater among women giving birth less than or equal to 36 hours after amniocentesis than among women giving birth less than or equal to 36 hours after amniocentesis (median lactate dehydrogenase, 173 U/L; p < 0.001). Critical values of lactate dehydrogenase greater than or equal to 225 U/L, leukocyte count greater than or equal to 10 cells/mm3 (1 0 x 106/L) and glucose less than or equal to 34 mg/dl (1.9 mmol/L) were selected for optimal performance in prediction of amniocentesis-to-delivery interval less than or equal to 36 hours. Lactate dehydrogenase level had the best sensitivity (74%) in prediction of delivery less than or equal to 36 hours after amniocentesis in contrast to leukocyte count (49%), glucose (62%), and positive Gram stain (26%). Amniotic fluid lactate dehydrogenase values greater than or equal to 225 U/L were associated with a fivefold greater risk for delivery less than or equal to 36 hours after amniocentesis (odds ratio 5.46, 95% confidence interval 2.00 to 14.87; p = 0.0006). CONCLUSION: Amniotic fluid lactate dehydrogenase level has diagnostic value in prediction of a positive amniotic fluid culture and delivery less than or equal to 36 hours after amniocentesis. Lactate dehydrogenase is a readily available, inexpensive, rapid amniotic fluid marker that can be measured in any hospital laboratory.