474 Does timing of triple I diagnosis during labor has influence on maternal and neonatal outcomes?

Abstract

To assess the impact of the timing of suspected TRIPLE I (intra-amniotic infection) diagnosis during term labor on maternal and neonatal complications rate A retrospective cohort study (6/2015-3/2019) of women who had a body temperature measurement ≥38°C during term labor (≥37 wks). Women were retrospectively classified into “isolated maternal fever” (IMF) or “suspected triple I" (III) according to the 2017 ACOG criteria. Those with III were further grouped according to the timing of diagnosis during labor: 1st stage or 2nd stage. Composite maternal and neonatal complications rates (Table 1) were compared between groups Out of the 27,344 deliveries during the study period, 595 women (2.17%) met the inclusion criteria, of whom, 93 (15.6%) had IMF and 502 (84.4%) had IiI. Of women with IiI, 324 (64.5%) were diagnosed in the 1st stage and 178 (35.5%) during the 2nd stage of labor, all received empiric antibiotics per the department protocol. Compared to women diagnosed during the 1st stage, those diagnosed during the 2nd stage of labor had a lower Cesarean delivery (CD) rate (29.3% vs. 6.7%, respectively; p<0.001) and a lower composite maternal complications rate (17.6% vs.10.1%, respectively; p=0.026). When only women who had a vaginal delivery were included (to control the difference in the CD rate), this difference did not remain significant between the groups (1st stage: 14.4% vs. 2nd stage: 10.2%, p=0.28). The composite neonatal complications rate didn't differ significantly between the groups (1st stage: 13.3% vs. 2nd stage: 9.6%, p=0.25). Although women diagnosed during the 2nd stage of labor had a significantly lower composite maternal complications rate, this difference disappeared when only vaginal deliveries were included to control the expected difference in the CD rates between groups. Similarly, there were no significant differences in the composite neonatal complications rate. Collectively, these data suggest that once III has been detected during labor and antibiotic treatment was given, its duration has limited impact on maternal and neonatal outcomes.