Is the New Terminology of “Triple I” For Chorioamnionitis Really Different? [10O

Abstract

INTRODUCTION: The proposed terminology of “Triple I” was developed to clarify the heterogeneity of manifestations associated with chorioamnionitis. This study aims to evaluate if those with a concordant (both histological and clinical) diagnosis of chorioamnionitis are different from those that do not meet the confirmed “Triple I” criteria. METHODS: Retrospective three-year analysis of term patients with chorioamnionitis classified as: 1) clinical (CCA)–via ICD-9 codes, 2) histological (HCA), 3) concordant. Variables evaluated: age, gravidity, white blood cell (WBC) count, gestational age, Group B Strep, rupture of membranes, epidural, highest temperature, fetal heart tracing prior to cesarean, Apgar score, infant sex, special care nursery (SCN) admission and presence of bandemia in infant. Analysis by multinomial logistic regression. RESULTS: In the CCA, HCA and concordant group there were 27, 51 and 23 subjects, respectively. When compared to the concordant group, three variables had statistical significance (P < 0.05). In CCA and HCA, for every one-unit increase in WBC they are 18.6% (95% CI 0.65-0.95) and 17.3% (95% CI 0.69-0.99) less likely to match with concordant group, respectively. The HCA group is 96.6% (95% CI 0.003-0.387) less likely to be a primigravida and are 12.3 times (95% CI 2.8-53.6) more likely not to have infant in SCN. CONCLUSION: Our analysis finds the concordant group (confirmed Triple-I) is similar to CCA and HCA group. In term patients, the terminology “Triple I” does not bring clarity to the diagnosis of chorioamnionitis. Therefore, additional research is needed to refine the diagnosis criteria. This will improve maternal and neonatal management by providers.