ISOLATION OF UREAPLASMA-UREALYTICUM FROM THE AMNIOTIC CAVITY AND ADVERSE OUTCOME IN PRETERM LABOR

Objective: To determine the relationship between the presence of Ureap lasma urealyticum in the amniotic cavity and adverse maternal and peri natal outcome in women with preterm labor. Methods: Amniocentesis was performed in 181 patients with preterm labor and intact membranes. Amn iotic fluid (AF) was cultured for aerobic and anaerobic bacteria and m ycoplasmas. Patients were divided into three groups according to the r esults of AF culture: those with negative AF cultures (n = 160), those with positive AF cultures and in whom the only microbial isolate was U urealyticum (n = 11), and those with positive cultures for non-ureap lasmas or mixed microorganisms (11 = 10). Survival techniques were use d for analysis. Results: The prevalence of positive AF cultures in whi ch the only microbial isolate was U urealyticum was 6.1% (11 of 181), and of positive cultures with non-ureaplasmas or mixed microorganisms was 5.5% (10 of 181). The amniocentesis-to-delivery interval was signi ficantly shorter in patients with positive cultures limited to U ureal yticum than in those with negative cultures (median 7 [range 0.1-149] hours versus median 264 [0.1-2659] hours, P <.001). Preterm delivery w ithin 48 hours, 72 hours, and 7 days was more frequent in patients wit h U Ill urealyticum in the AF than in those with sterile AF (48 hour: 91% versus 33%; 72 hour: 91% versus 36%; 7 days: 100% versus 45%, P <. 001 for each). Patients with positive AF cultures limited to U urealyt icum had a significantly higher rate of adverse perinatal outcome than those with negative culture. Adverse outcomes included low gestationa l age at birth, low birth weight, histologic chorioamnionitis, signifi cant neonatal morbidity, and perinatal death. Conclusion: Microbial in vasion of the amniotic cavity with U urealyticum is a risk factor for impending preterm delivery and adverse perinatal outcome. (C) 1998 by The American college of Obstetricians and Gynecologists.