614: Adverse maternal outcomes associated with chorioamnionitis

Abstract

Chorioamnionitis complicates 1-5% of all pregnancies and is associated with substantial neonatal morbidity. Prolonged labor and increased utilization of labor induction may lead to increased rates of chorioamnionitis. We sought to quantify adverse maternal outcomes associated with chorioamnionitis in a contemporary population of live births in the state of Ohio. Population-based retrospective cohort study of all live births in Ohio (2006–2015). Maternal demographic and obstetric outcomes as reported on the US birth certificate were compared between women with and without chorioamnionitis. Primary study outcomes were maternal intensive care unit (ICU) admission and composite adverse maternal outcome (blood product transfusion, unplanned hysterectomy, unplanned operation after delivery, ruptured uterus, and maternal ICU admission). Multivariate logistic regression estimated the relative association of chorioamnionitis with maternal adverse outcomes. Of 1,393,054 live births in Ohio during the 10-year study period, 17,430 live births (1.3%) had chorioamnionitis (chorio). Women with chorio had significantly higher rates of maternal ICU admission (0.5 vs 0.1%, p<0.001) and composite adverse outcome (5.0 vs 1.5%, p<0.001) compared to those without chorio. Even after adjustment for coexisting risks in multivariate analyses, chorio is associated with 3-4 fold increased risk of composite adverse outcome, maternal ICU admission, blood transfusion, ruptured uterus and unplanned operation after delivery (Table). Sensitivity analysis excluding women delivered by cesarean revealed persistent significant associations between chorio and all adverse maternal outcomes with the exception of uterine rupture (Table). Composite adverse outcome rates were higher at earlier gestation, however the relative risk of adverse outcome increased with advancing gestational age at delivery (Figure). The frequency of severe adverse outcomes in pregnancies complicated with chorio is high, with one in every 20 cases affected, including greater than 4-fold increased risk for maternal ICU admission. Efforts to prevent and treat chorioamnionitis to minimize maternal risk could be an important area of focus in reducing the rate of severe maternal morbidity in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)