Chorioamnionitis diagnostic study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
There is no single diagnostic study of choice for the [[diagnosis]] of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, [[laboratory]] findings, and/or [[histopathologic]] evaluation. The diagnosis of clinical chorioamnionitis is solely based on clinical features include maternal [[fever]], [[uterine]] tenderness, maternal/fetal [[tachycardia]], and foul-smelling/purulent [[amniotic fluid]]. And the [[gold standard (test)]] for the diagnosis of chorioamnionitis is a [[microbiological culture]] of the [[amniotic fluid]]. | |||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
===Study of choice=== | ===Study of choice=== | ||
There is no single diagnostic study of choice for the [[diagnosis]] of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, [[laboratory]] findings, and/or [[histopathologic]] evaluation.<ref name="pmid20569811">{{cite journal |vauthors=Tita AT, Andrews WW |title=Diagnosis and management of clinical chorioamnionitis |journal=Clin Perinatol |volume=37 |issue=2 |pages=339–54 |date=June 2010 |pmid=20569811 |pmc=3008318 |doi=10.1016/j.clp.2010.02.003 |url=}}</ref> | There is no single diagnostic study of choice for the [[diagnosis]] of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, [[laboratory]] findings, and/or [[histopathologic]] evaluation.<ref name="pmid20569811">{{cite journal |vauthors=Tita AT, Andrews WW |title=Diagnosis and management of clinical chorioamnionitis |journal=Clin Perinatol |volume=37 |issue=2 |pages=339–54 |date=June 2010 |pmid=20569811 |pmc=3008318 |doi=10.1016/j.clp.2010.02.003 |url=}}</ref> | ||
*The diagnosis of clinical chorioamnionitis is solely based on clinical features, which include '''maternal fever > 100.4 F''' and at least two of the following clinical findings: | |||
*The diagnosis of clinical chorioamnionitis is solely based on clinical features, which include '''maternal | |||
**[[Uterine]] tenderness | **[[Uterine]] tenderness | ||
**Maternal/fetal [[tachycardia]] | **Maternal/fetal [[tachycardia]] | ||
**Foul-smelling/purulent [[amniotic fluid]] | **Foul-smelling/purulent [[amniotic fluid]] | ||
*The [[microbiological culture]] of the [[amniotic fluid]] is the [[gold standard (test)]] for the diagnosis of chorioamnionitis. However, due to the disadvantages of this diagnostic study (e.g., [[invasive]] nature of the test, potential [[side effects]], etc.), it is usually preserved for suspected cases with lack of clinical diagnostic criteria to confirm the diagnosis. | |||
*The diagnosis of [[histologic]] chorioamnionitis is based on the histologic confirmation of chorioamnionitis with the presence of [[leukocyte]] infiltration of fetal membranes and/or [[umbilical]] vasculitis (funisitis). | |||
===The comparison of various clinical features for the diagnosis of chorioamnionitis=== | ===The comparison of various clinical features for the diagnosis of chorioamnionitis=== | ||
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==References== | ==References== | ||
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[[Category:Obstetrics]] | |||
[[Category:Inflammations]] | |||
[[Category:Bacterial diseases]] | |||
Latest revision as of 16:01, 12 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
There is no single diagnostic study of choice for the diagnosis of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, laboratory findings, and/or histopathologic evaluation. The diagnosis of clinical chorioamnionitis is solely based on clinical features include maternal fever, uterine tenderness, maternal/fetal tachycardia, and foul-smelling/purulent amniotic fluid. And the gold standard (test) for the diagnosis of chorioamnionitis is a microbiological culture of the amniotic fluid.
Diagnostic Study of Choice
Study of choice
There is no single diagnostic study of choice for the diagnosis of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, laboratory findings, and/or histopathologic evaluation.[1]
- The diagnosis of clinical chorioamnionitis is solely based on clinical features, which include maternal fever > 100.4 F and at least two of the following clinical findings:
- Uterine tenderness
- Maternal/fetal tachycardia
- Foul-smelling/purulent amniotic fluid
- The microbiological culture of the amniotic fluid is the gold standard (test) for the diagnosis of chorioamnionitis. However, due to the disadvantages of this diagnostic study (e.g., invasive nature of the test, potential side effects, etc.), it is usually preserved for suspected cases with lack of clinical diagnostic criteria to confirm the diagnosis.
- The diagnosis of histologic chorioamnionitis is based on the histologic confirmation of chorioamnionitis with the presence of leukocyte infiltration of fetal membranes and/or umbilical vasculitis (funisitis).
The comparison of various clinical features for the diagnosis of chorioamnionitis
Although the sensitivity of clinical findings for chorioamnionitis is very high (i.e., maternal fever with 95% sensitivity), their specificities are low. Measurement of accuracy is based on both sensitivity and specificity.[2]
| Findings | Accuracy |
|---|---|
| Maternal fever | 30% |
| Maternal tachycardia | 51.1% |
| Fetal tachycardia | 57.8% |
| Maternal leukocytosis | 55.6% |
| Uterine tenderness | 48.9% |
| Malodorous amniotic fluid | 46.7% |
The comparison of various amniotic fluid parameter for the diagnosis of chorioamnionitis
The sensitivity and specificity of amniotic fluid parameters for the diagnosis of chorioamnionitis are indicated in the table below.[1]
| Test | Sensitivity | Specificity |
|---|---|---|
| Culture (Amniotic fluid) | Gold | standard |
| Gram stain (Amniotic fluid) | 24% | 99% |
| Glucose level (Amniotic fluid) | 57% | 74% |
| IL-6 (Amniotic fluid) | 81% | 75% |
| Matrix metalloproteinase (Amniotic fluid) | 90% | 80% |
| White blood cell count (Amniotic fluid) | 57% | 78% |
| Leukocyte esterase (Amniotic fluid) | 85%-91% | 95%-100% |
References
- ↑ 1.0 1.1 Tita AT, Andrews WW (June 2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
- ↑ Burke C, Chin EG (2016). "Chorioamnionitis at Term: Definition, Diagnosis, and Implications for Practice". J Perinat Neonatal Nurs. 30 (2): 106–14. doi:10.1097/JPN.0000000000000163. PMID 27104601.