The Value of the Leukocyte Esterase Test in Diagnosing Intra-Amniotic Infection

Roberto Romero; Mohamed Emamian; Macor Wan; Shaul Yarkoni; William McCormack; Moshe Mazor; John C. Hobbins

doi:10.1055/s-2007-999657

American Journal of Perinatology, Table of Contents

Am J Perinatol 1988; 5(1): 64-69
DOI: 10.1055/s-2007-999657

ORIGINAL ARTICLE

The Value of the Leukocyte Esterase Test in Diagnosing Intra-Amniotic Infection

Roberto Romero, Mohamed Emamian, Macor Wan, Shaul Yarkoni, William McCormack, Moshe Mazor, John C. Hobbins

The Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut; and The Section of Infectious Disease, Department of Medicine, Downstate University, Brooklyn, New York

Abstract

ABSTRACT

This communication examines the diagnostic value of the leukocyte esterase activity (LEA) test in the detection of intra-amniotic infection. Amniotic fluid from 171 consecutive patients with premature rupture of membranes (n = 149) and preterm labor (n = 22) was obtained through amniocentesis. Gram stain, bacterial and mycoplasma cultures, and LEA tests were performed. The LEA had a sensitivity of 19%, a specificity of 86.7%, a positive predictive value (PPV) of 42.3% and a negative predictive value (NPV) of 67.6% in the prediction of a positive amniotic fluid culture (prevalence of positive cultures = 33.9%). The Gram stain had a sensitivity of 36.2%, specificity of 94.7%, PPV of 77.8%, and NPV of 74.3%. When both tests were combined, a significant increase in sensitivity to 50% was observed. This was associated with a drop in specificity to 81.4%. There was a correlation between the number of white blood cells in the amniotic fluid and the result of the LEA test. A positive LEA assay was associated with an increased likelihood of postpartum endometritis, but not with clinical chorioamnionitis or neonatal infectious morbidity.

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