Intraamniotic infection is considered a major etiologic factor of preterm birth. Positive amniotic fluid cultures are rarely contaminated with Candida species. The presence of this microorganism is associated with a poor pregnancy outcome. Out of 773 transabdominal amniocenteses performed in women presenting with preterm labor and intact membranes, 77 patients (9.9%) had positive amniotic fluid cultures and in 5 women (6.5%) Candida species were identified. On the other hand, 625 amniocenteses were performed in women with preterm premature rupture of membranes and 178 (28%) had positive cultures. Only in 4 patients was Candida isolated (2.2%) (P = 0.13 Fisher's exact test). The importance of early and accurate diagnosis of intraamniotic infection with Candida is pointed out. A transabdominal amniocentesis for microbiological examination is suggested for every woman presenting with preterm labor or preterm premature rupture of membranes and especially for those who conceived with a retained IUD or cervical cerclage.
PIP: The clinical significance of intraamniotic infection with Candida species for women with preterm labor was reviewed based on a Medline search from 1966-1991, retrieving 19 documents. The pooled data of 773 transabdominal amniocenteses from women in preterm labor revealed positive cultures in 9.9%, in which Candida species were identified in 6.5%. A further 625 amniocenteses were performed on women presenting with preterm premature rupture of the membranes, of whom 28% had positive cultures and 2.2% had Candida. A series of 58 amniocentesis samples from women at term, drawn for lung maturity tests, found none positive for Candida. It is interesting that Candida, common in the vagina, is an unusual pathogenic cause of preterm labor; while Mycoplasma hominis and Ureaplasma urealyticum, organisms commonly found in the female genital tract, are important causes of amniotic infection; yet Fusobacterium, a very rare vaginal resident, is the most commonly isolated etiologic organism in preterm labor. Many of the reported cases of preterm labor or premature rupture of the membranes were associated with retained IUDs, and some with cervical cerclage. Candida is known to cause cerebral infections in the fetus, and often colonizes the oral cavity of newborns. Therefore to improve pregnancy outcome, it is best to treat Candida infections in pregnant women.