Chorioamnionitis diagnostic study of choice: Difference between revisions

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Revision as of 13:54, 7 June 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D [2]

Overview

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 microbiological culture of the amniotic fluid is the gold standard (test) for the diagnosis of chorioamnionitis. However, the disadvantage of this diagnostic study is the invasive nature of the test and potential side effects.
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 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.

[pmid20569811-1] 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.

[pmid27104601-2] 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.

[1]

[2]

@@ Line 7: / Line 7: @@
 ==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.
+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 microbiological culture of the amniotic fluid is the gold standard test for the diagnosis of chorioamnionitis.
+*The [[microbiological culture]] of the [[amniotic fluid]] is the [[gold standard (test)]] for the diagnosis of chorioamnionitis. However, the disadvantage of this diagnostic study is the [[invasive]] nature of the test and potential [[side effects]].
+*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 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.<ref name="pmid27104601">{{cite journal |vauthors=Burke C, Chin EG |title=Chorioamnionitis at Term: Definition, Diagnosis, and Implications for Practice |journal=J Perinat Neonatal Nurs |volume=30 |issue=2 |pages=106–14 |date=2016 |pmid=27104601 |doi=10.1097/JPN.0000000000000163 |url=}}</ref>
+Although the [[sensitivity]] of clinical findings for chorioamnionitis is very high (i.e., maternal fever with 95% sensitivity), their [[specificity|specificities]] are low. Measurement of [[accuracy]] is based on both [[sensitivity]] and [[specificity]].<ref name="pmid27104601">{{cite journal |vauthors=Burke C, Chin EG |title=Chorioamnionitis at Term: Definition, Diagnosis, and Implications for Practice |journal=J Perinat Neonatal Nurs |volume=30 |issue=2 |pages=106–14 |date=2016 |pmid=27104601 |doi=10.1097/JPN.0000000000000163 |url=}}</ref>
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Findings
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Accuracy
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Accuracy]]
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal fever
+! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal [[fever]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |30%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal tachycardia
+! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal [[tachycardia]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |51.1%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Fetal tachycardia
+! style="background: #696969; color: #FFFFFF; text-align: center;" |Fetal [[tachycardia]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |57.8%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal leukocytosis
+! style="background: #696969; color: #FFFFFF; text-align: center;" |Maternal [[leukocytosis]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |55.6%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Uterine tenderness
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Uterine]] tenderness
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |48.9%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Malodorous amniotic fluid
+! style="background: #696969; color: #FFFFFF; text-align: center;" |Malodorous [[amniotic fluid]]
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |46.7%
 |}
 ===The comparison of various amniotic fluid parameter 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. The sensitivity and specificity of other diagnostic studies are indicated in the table below.<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 [[sensitivity]] and [[specificity]] of [[amniotic fluid]] parameters for the diagnosis of chorioamnionitis are indicated in the table below.<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>
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Sensitivity]]
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Specificity]]
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Culture (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[microbiological culture|Culture]] ([[Amniotic fluid]])
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Gold
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Standard
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |standard
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Gram stain (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Gram stain]] ([[Amniotic fluid]])
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |24%
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |99%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Glucose level (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Glucose]] level ([[Amniotic fluid]])
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |57%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |74%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |IL-6 (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[IL-6]] ([[Amniotic fluid]])
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |81%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |75%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Matrix metalloproteinase (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Matrix metalloproteinase]] ([[Amniotic fluid]])
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |90%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |80%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |White blood cell count (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[White blood cell]] count ([[Amniotic fluid]])
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |57%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |78%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Leukocyte esterase (Amniotic fluid)
+! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Leukocyte esterase]] ([[Amniotic fluid]])
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |85%-91%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |95%-100%
+|}
-|}
 ==References==