Cardiotocograph (CTG) changes and maternal and neonatal outcomes in chorioamnionitis and/or funisitis confirmed on histopathology

Abstract

ObjectiveTo assess the cardiotocographic changes and maternal and neonatal outcomes in cases of chorioamnionitis and or funisitis confirmed on histopathology. Study DesignA retrospective analysis of histopathology reports confirming chorioamnionitis and/or funisitis was carried out from 2014 to 2020 in a single centre. The preterm births (<37 weeks) were excluded. The maternal records were reviewed to determine the maternal and neonatal outcomes such as the mode of delivery, intrapartum and postpartum complications, umbilical cord arterial pH, and admission to the special care baby unit (SCBU). The CTG features were analysed on admission and during the intrapartum period. The study was approved by the Audit and Clinical Effectiveness department within the centre. ResultsOut of the 57 cases of histologically confirmed chorioamnionitis and/or funisitis, 42 women (73.7 %) had intrapartum pyrexia and none of the mothers had an increased temperature at the point of fetal tachycardia (persistent increase in baseline fetal heart rate (FHR) by >10 % compared to the original baseline FHR). 43 (75.4 %) CTGs showed evidence of uterine tachysystole or hyperstimulation. 15 (26.3 %) cases had meconium stained amniotic fluid (MSAF). 54 (94.7 %) women had a caesarean section, and their babies were admitted to special care baby unit after delivery. 54 (94.7 %) babies had an umbilical artery of more than 7.1. 47 (87 %) of the women were readmitted with wound infection.All CTG traces showed a > 10 % increase in the baseline FHR and variable decelerations with overshoot were noted in cases where funisitis was confirmed in 25 cases (92.6 %). Loss of cycling was noted in 54 CTGs (94.7 %) and a sinusoidal pattern was identified in 27 (47.3 %). ConclusionRising (>10 %) baseline during labour along with loss of cycling with or without features of tachysystole or hyperstimulation should be considered in labour as features of ongoing chorioamnionitis. Chorioamnionitis confirmed on histopathology is associated with an increase in caesarean section rate due to fetal heart rate changes, increased risk of wound infection in mothers, and increased admission of the babies to SCBU.