The clinical significance of detecting Ureaplasma urealyticum by the polymerase chain reaction in the amniotic fluid of patients with preterm labor.

OBJECTIVE: This study was undertaken to determine the clinical significance of a detection of Ureaplasma urealyticum by using the polymerase chain reaction (PCR) in the amniotic fluid of patients with preterm labor and intact membranes.

STUDY DESIGN: Amniocentesis was performed in 257 patients with preterm labor and intact membranes. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as genital mycoplasmas. U urealyticum was detected by PCR using specific primers. Patients were divided into 3 groups according to the results of amniotic fluid culture and PCR for U urealyticum: those with a negative culture and negative PCR (n=228), those with a negative culture but positive PCR (n=6), and those with a positive culture regardless of the results of PCR (n=23).

RESULTS: The prevalence of positive amniotic fluid culture was 9% (23 of 257). U urealyticum was detected by PCR in 6% (15 of 254) of cases. Of the 15 cases with positive PCR for U urealyticum, amniotic fluid culture was negative in 40% (6 of 15). Patients with a negative culture but positive PCR for U urealyticum had significantly shorter median amniocentesis-to-delivery interval and higher amniotic fluid interleukin-6 and white blood cell count than those with a negative amniotic fluid culture and negative PCR (P<.01 for each). Patients with a positive PCR for U urealyticum but a negative amniotic fluid culture had a higher rate of significant neonatal morbidity than those with a negative culture and negative PCR (P<.05). However, no significant differences in perinatal outcome were observed between patients with a negative culture but positive PCR and those with a positive amniotic fluid culture.

CONCLUSION: Patients with preterm labor and a positive PCR for U urealyticum but negative amniotic fluid culture are at risk for impending preterm delivery and adverse perinatal outcome.