Amniotic fluid index values after preterm premature rupture of the membranes and subsequent perinatal infection

Objective: Our purpose was to determine whether an amniotic fluid index (AFI) <5 cm after preterm premature rupture of the membranes is associated with an increased risk of perinatal infection. Study Design: We performed a nonconcurrent prospective analysis of 225 singleton pregnancies complicated by preterm premature rupture of the membranes, with delivery between 24 and 32 weeks’ gestation. All included patients received 2 doses of betamethasone antenatally, in the first 24 hours after admission, and broad-spectrum antibiotic prophylaxis. Patients were categorized into 2 groups on the basis of a 4-quadrant AFI <5 cm (n = 131) or ≥5 cm (n = 94). Perinatal outcomes analyzed included latency until delivery, mode of delivery, and frequencies of clinical chorioamnionitis, postpartum endometritis, and culture-proved early neonatal sepsis. Continuous data were evaluated for normal distribution and tested for significance with the Student t test. Categoric data were tested with the χ2 and Fisher exact tests. Multiple logistic regression analyses were performed with chorioamnionitis, endometritis, and early-onset neonatal sepsis each as the dependent variable in separate analyses. All 2-sided P values < .05 were considered significant. Results: Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, birth weight, and maternal group B streptococcal colonization. Patients with an AFI <5 cm demonstrated a shorter mean latency until delivery (5.5 ± 4.0 vs 14.1 ± 5.2) (mean ± SD) days (P = .02), greater frequency of amnioinfusion therapy (23.6% vs 5.3%) (P< .001), and cesarean delivery for nonreassuring fetal testing (18.3% vs 4.3%) (P = .01). Multiple logistic regression analysis showed that an AFI <5 cm was the only significant risk factor independently associated with early-onset neonatal sepsis (P = .004) and chorioamnionitis (P = .024). Conclusions: An AFI <5 cm after preterm premature rupture of the membranes between 24 and 32 weeks’ gestation is associated with an increased risk of perinatal infection and a shorter latency preceding delivery. (Am J Obstet Gynecol 2000;183:271-6.)