Sung et al compared different criteria for the diagnosis of acute chorioamnionitis. The diagnosis of chorioamnionitis is important for planning early delivery and recognition of early onset neonatal sepsis. The authors are from Sungkyunkwan University in Seoul, Korea.
Patient selection: pregnant woman with suspected chorioamnionitis
Parameters:
(1) fever (temperature >= 37.8°C)
(2) leukocytosis (WBC > 15,000 per µL), based on highest value prior to delivery
(3) maternal tachycardia (heart rate > 100 beats per minute)
(4) fetal tachycardia (heart rate > 160 beats per minute)
(5) uterine tenderness
(6) foul smelling vaginal discharge
(7) positive maternal C-reactive protein (>= 1.0 mg/dL by immunoturbidimetry), based on highest value prior to delivery
(8) neutrophil left shift
Criteria 1 (criteria of Gibbs, 1977) - both of the following:
(1) fever (item 1)
(2) >= 2 of items 2 to 6
Criteria 2:
(1) >= 3 of items 1 to 6
Criteria 3 (modified Gibbs) - both of the following:
(1) fever (item 1)
(2) >= 2 of items 2 to 8
|
Measure
|
Criteria 1
|
Criteria 2
|
Criteria 3
|
|
sensitivity
|
15%
|
34%
|
17%
|
|
specificity
|
92%
|
78%
|
92%
|
|
Youden index
|
0.08
|
0.13
|
0.08
|
|
positive predictive value
|
24%
|
20%
|
24%
|
|
negative predictive value
|
87%
|
88%
|
87%
|
