AMNIOTIC-FLUID LEUKOCYTES AND LEUKOCYTE ESTERASE-ACTIVITY IN PARTURIENTS DELIVERED BY CESAREAN-SECTION

Amniotic fluid specimens from parturients undergoing caesarean deliver y were examined for leukocytes and leukocyte esterase activity, as wel l as for amniotic fluid bacteria and mycoplasmas by cultivation, The a im of this study was to evaluate the intrauterine environment in nonin fected parturients and the associations between leukocyte test results , amniotic fluid microbial colonization and postcaesarean endometritis . Samples were obtained by direct aspiration at operation from 289 par turients with no clinical intrauterine infection. Among the total stud y population, leukocytes were found in 41% of the amniotic fluid sampl es by Gram staining and in 39% of tile samples by the leukocyte estera se activity test. Leukocytes and leukocyte esterase activity were obse rved significantly more often in the amniotic fluids of parturients un dergoing operation after onset of labour or ruptured membranes compare d with those operated upon with intact membranes and no labour (p < 0. 0001 and p < 0.0001). Of 255 amniotic fluid cultures, microbial coloni zation was observed in 82 (32%) parturients, Positive results in the l eukocyte tests were associated significantly with amniotic fluid micro bial colonization among parturients who underwent operation with intac t membranes, or who underwent operation after rupture of the membranes and had cervical dilatation of <5 cm at the operation (Gram stain: p < 0.0001; leukocyte esterase: p < 0.003). If cervical dilatation was g reater than or equal to 5 cm, no such association was observed. In the populations studied, endometritis developed in 2% and 4% of the partu rients with positive test results, Thus, neither the presence of leuko cytes nor detected leukocyte esterase activity were predictive of subs equent postoperative endometritis. In the detection of amniotic fluid microbial colonization, the tests functioned best in non-labouring par turients with intact membranes and in those operated on at the early s tage of labour.