Maternal and peripartum risk factors for acute funisitis among term deliveries complicated by intraamniotic infection

Abstract

Acute funisitis (AF), the histologic diagnosis of inflammation within the umbilical cord, represents a fetal inflammatory response and has been associated with adverse neonatal outcomes. There is little known regarding the maternal and intrapartum risk factors associated with the development AF among term deliveries complicated by intraamniotic infection (IAI). To identify maternal and intrapartum risk factors associated with developing AF among term deliveries complicated by IAI. After IRB approval, we conducted a retrospective cohort study of term deliveries affected by clinical IAI at a single tertiary center between 2013-2017 with placental pathology consistent with histologic chorioamnionitis. Exclusion criteria included intrauterine fetal demise, missing delivery information or placental pathology, and documented congenital fetal abnormalities. Maternal sociodemographic, antepartum, and intrapartum factors were compared among patients with AF on pathology to those without AF using bivariate statistics. Regression models developed to estimate adjusted odds ratios (aOR). Of 123 patients meeting inclusion criteria, 75 (61%) had AF on placental pathology. Compared to placental specimens without AF, AF was observed more frequently among patients with maternal body-mass-index (BMI) ≥ 30kg/m2 (58.7% vs, 39.6%, p=0.04) and labor courses with increased rupture of membrane (ROM) duration (17.3 vs, 9.6 hours, p=0.001). Use of fetal scalp electrode (FSE) was observed less frequently in AF (5.3% vs, 16.7%, p=0.04) compared to cases without AF. In regression models, maternal BMI≥30kg/m2 (aOR 2.67, 95% CI 1.21,5.90) and ROM >18 hours (aOR 2.48, 95% CI 1.07,5.75) were significantly associated with AF. FSE use (aOR 0.18, 95% CI 0.04,0.71) was negatively associated with AF. In term deliveries with IAI and histologic chorioamnionitis, maternal BMI≥30kg/m2, and ROM>18 hours were associated with AF on placental pathology. As insight into the clinical impact of AF grows, the ability to predict which pregnancies are at greatest risk for its development may allow for a tailored approach to predicting neonatal risk for sepsis and related comorbidity.