Incidence Of Clinical Chorioamnionitis Research Articles

Incidence of histologic chorioamnionitis in a rural community hospital.

Histological chorioamnionitis (HCA) is a pathological condition defined as an acute inflammation of the amniochorionic membranes which has been linked to a wide range of adverse neonatal events. The purpose of this study is to identify the incidence of HCA in the rural population and evaluate whether there are significant differences in these incidences within the different clinical parameters of delivery method, gravidity, gestational age, previous cesarean section, reason for cesarean section and body mass index (BMI). A retrospective chart review was conducted on 462 consecutive deliveries that occurred in a rural hospital during a four-year period. Data collected was analyzed using independent sample T-tests, chi-squared tests, and descriptive statistics, with a p-value of < 0.05. Overall incidence of HCA was 15.9% (73/459), with a term incidence of 16.2% (68/421) and preterm incidence of 13.2% (5/38). The incidence of HCA was significantly higher in vaginal deliveries (18.8%; n = 54/288) than C-section deliveries (11.1%; n = 19/171) (p = 0.03). Incidence of clinical chorioamnionitis was 0.43% (2/462), with 2.74% (2/73) of HCA manifesting clinically. Evaluation of the incidence of HCA and associated clinical parameters in this study showed a marked decrease in the incidence of HCA when compared to other studies. Strategies to reduce the incidence of HCA include reducing the length of labor via active labor management. We hypothesize that these findings are due to the consistent use of active labor management and our rural study population, but further investigation is required to confirm this.

Perinatal Risk Factors for the Development of Neonatal Intraventricular Hemorrhage in Preterm Infants

Background: To evaluate the impact perinatal factors closely related to the development of neonatal intraventricular hemorrhage (IVH) in preterm infants. Methods: A retrospective case-control study was performed on premature infants born in our perinatal center in 2014–2018. Neonates with IVH were age-matched with normal controls (1:5). Perinatal factors were compared between cases and controls. Results: Fourteen cases and 70 controls had a median of 26.5 (range 22–29) weeks gestational age. Significant difference was observed regarding the incidence of clinical chorioamnionitis (43% and 14%, p = 0.023) and the use of magnesium sulfate (MgSO4) (14% and 51%, p = 0.017). Adjusted odds ratios (95% confidence interval) were 8.3 (1.8–38) in clinical chorioamnionitis and 0.15 (0.03–0.76) in magnesium sulfate. Conclusions: Relevant perinatal factor of IVH in premature infants born before 30 weeks of gestation was strongly associated with clinical chorioamnionitis. Furthermore, MgSO4 exposure suggested a neuroprotective effect against IVH.

Clinical Significance of Oligohydramnios in Patients with Preterm Premature Rupture of Membranes

Background. Preterm premature rupture of membranes (PPROM) is one of the main causes of perinatal morbidity and mortality. Associated oligohydramnios may further exacerbate the condition leading to intra-amniotic inflammation and adverse obstetric and perinatal outcomes in preterm labor.Aim of the research. To determine an impact of oligohydramnios on patients with preterm premature rupture of membranes.Materials and methods. We performed a retrospective analysis of two groups of patients with PPROM: 56 patients with oligohydramnios were included in the main group, 111 patients without oligohydramnios were included in the control group. The gestational age varied from 24+0 weeks to 33+6 weeks. Amniotic fluid index, endocervical culture, leukogram and neutrophil-to-lymphocyte ratio (NLR), serum procalcitonin and C-reactive protein levels were assessed in all participants.Results. We witnessed a plethora of consequences in the group of women with PPROM and oligohydramnios: shorter latent phase, higher incidence of clinical chorioamnionitis, antenatal fetal distress, higher levels of C-reactive protein, leukocytes, neutrophils and NLR, lower level of lymphocytes, and increased growth of potentially pathogenic cervical flora. Moreover, the patients with oligohydramnios demonstrated a significantly higher rate of cesarean delivery. The combination of PPROM and oligohydramnios also take a toll on the condition of the newborns: they have lower 5-minute Apgar score and higher prevalence of respiratory distress syndrome, congenital pneumonia, and necrotizing enterocolitis. Furthermore, newborns from the main group are more likely to be admitted to the neonatal intensive care unit, compared with newborns from the control group.Conclusion. Oligohydramnios in PPROM is associated with a dramatic rise of numerous complications affecting both the women and the newborns.

Impact of New 'Triple I' Classification on the Incidence of Clinical Chorioamnionitis and Antibiotic Use in Neonates

Impact of New 'Triple I' Classification on the Incidence of Clinical Chorioamnionitis and Antibiotic Use in Neonates

Does Antepartum Vitamin D3 Supplementation Prevent Chorioamnionitis? [24P

INTRODUCTION: To determine the relationship between maternal Vitamin D status and the incidence of clinical chorioamnionitis and endometritis. METHODS: Nested case-control study performed 10/2016-5/2018 enrolled women from 12-16 weeks gestation. Women were excluded if taking Vitamin D3 supplements, had a malabsorption disorder, or carrying an anomalous fetus. Women were assigned to receive daily Vitamin D3 3000IU or no supplementation. Maternal demographics, baseline Vitamin D3 status, and pregnancy outcomes were collected. Clinical chorioamnionitis was defined as presence of elevated temperature of >39 C or 38 C occurring twice 30 minutes apart with fetal tachycardia, maternal tachycardia, purulent vaginal discharge or uterine tenderness. Endometritis was defined as elevated temperature and uterine tenderness in the postpartum period. Parametric and nonparametric statistics were performed. A p value of <0.05 was statistically significant. RESULTS: There were 210 women included, 103 in the Vitamin D3 supplementation group and 107 in the no supplementation group. There were no significant differences in baseline characteristics between the groups. The incidence of maternal infection was 4.8% (10/210). Women with Vitamin D deficiency had a significant higher risk for the development of chorioamnionitis (12.9 vs. 0%; OR 20.7; p=0.003). Women who were Vitamin D deficient, with or without supplementation, had an increased risk of chorioamnionitis (8.8 vs. 0%; OR 13.4; p=0.02). There was no association between Vitamin D3 status and endometritis. CONCLUSION: Women who are Vitamin D deficient, with or without antepartum Vitamin D supplementation, are at an increased risk for chorioamnionitis. Optimization of Vitamin D status may be considered in prevention of maternal infection.

Impact of New “Triple I” Classification on the Incidence of Clinical Chorioamnionitis and Antibiotic Use in Neonates

Background: The CDC currently recommends blood culture and empiric antibiotics for all neonates born to mothers with suspected chorioamnionitis (CDC 2010). This can lead to excess antibiotic exposure and separation from mothers. To limit use of antibiotics, NICHD workshop (Obstet Gynecol, 2016) and ACOG (2017) proposed new criteria for the diagnosis of intrauterine infection, inflammation or both (Triple I). Objective: To evaluate the impact of new Triple I criteria on the incidence of chorioamnionitis and the use of antibiotics in …

Histological chorioamnionitis in placenta and preterm birth

Objective To investigate the causes and mechanism of preterm birth through analysis of the relationship between histological chorioamnionitis (HCA) in placental tissue and preterm birth. Methods Totally, 327 preterm birth cases with report of placental pathologic examination were retrospectively collected from those women who delivered from December 1, 2009 to December 1, 2012 in Peking University First Hospital. According to the etiology of preterm birth, three groups were assigned: iatrogenic group (n=106), spontaneous contraction group (n=56) and premature rupture of membranes (PROM) group (n=165). According to the gestational age at delivery, three subgroups were further divided: early-preterm group (≥28-<32 weeks), mid-preterm group(≥32-<34 weeks) and late-preterm group (≥34-<37 weeks). HCA was confirmed when ≥5 neutrophil infiltration identified on the chorionic plate and amniotic membrane under high power light microscope after HE staining. The relationship between HCA and the different types of preterm birth and the different delivery gestational age were analyzed. Besides, the consistency between clinical chorioamnionitis and HCA was also analyzed. Chi-square test was applied for statistics. Results The incidence of HCA in the spontaneous contraction group was significantly higher than in the iatrogenic group and PROM group [66.1% (37/56) vs 25.5% (27/106) and 33.3% (55/165), χ2=25.27 and 18.44, both P 0.05). Among the three subgroups, the early-, mid- and late-preterm subgroup, the incidence of HCA in the iatrogenic group was 24.0% (6/25), 33.3% (8/24) and 22.8% (13/57) (P>0.05), and 13/17, 5/7 and 59.4% (19/32) in the spontaneous contraction group (P>0.05). However, significantly higher incidence of HCA was shown in the early-preterm subgroup than in the mid- and late-preterm subgroup [70.0% (20/29) vs 41.2% (14/34) and 20.6% (21/102), χ2=4.87 and 24.58, both P<0.05] in the PROM group. Among the subjects in PROM group, those with the latency ≥72 h after the rupture of membranes had a higher incidence of HCA than those with the latency less than 72 h [68.6% (24/35) vs 23.8% (31/130), χ2=24.82, P<0.01]. For all 327 cases in this study, the incidence of clinical chorioamnionitis was 15.9% (52/327), among which 31 cases [59.6% (31/52)] were diagnosed as HCA. Conclusions The occurrence of HCA is closely associated with spontaneous contraction preterm. Some iatrogenic preterm birth might cause HCA. The earlier the preterm birth and the longer the latency after PROM, the higher the incidence of HCA. Differential diagnosis is necessary as the inconsistency between clinical chorioamnionitis and HCA. Key words: Chorioamnionitis; Premature birth; Fetal membranes, premature rupture

Active Versus Expectant Management for Preterm Prelabor Rupture of Membranes at 34–36 Weeks of Completed Gestation: Comparison of Maternal and Neonatal Outcomes

There is general agreement among obstetricians that women with preterm prelabor rupture of membranes (PPROM) should be expectantly managed at least until 34 completed weeks of gestation. However, there is little agreement concerning the choice between active management (AM) and expectant management (EM) from 34 to 36 weeks of gestation, and the choice during this period remains highly controversial. Four randomized trials compared EM with AM in cases of PPROM before 37 weeks. These studies reported no overall difference between these 2 types of management for length of stay in the neonatal intensive unit, respiratory distress syndrome (RDS), or confirmed neonatal sepsis, but clinical chorioamnionitis was found less frequently in AM than in EM. Because of design problems, the external validity of these 4 studies is unclear. This retrospective multicenter study compared the effect of management with AM or EM on maternal and neonatal outcomes among a population of women who had PPROM at 34 to 36 completed weeks of gestation. Outcomes examined included maternal chorioamnionitis and neonatal morbidity including neonatal infection, respiratory problems, and metabolic disorders. Respiratory problems examined included RDS and the need for oxygen supplementation for more than 2 hours. Data were obtained from medical charts for deliveries occurring between 1999 and 2005 at 3 university hospital centers. Of the 51,997 women who gave birth during the study period, 634 were admitted for PPROM at 34 to 36 completed weeks of gestation. A total of 393 women did not meet eligibility criteria and were excluded from analysis, leaving 241 women—126 in the EM group and 115 in the AM group. The incidence of clinical chorioamnionitis was significantly higher in the EM group compared with the AM group (4.8% vs. 0.9%; (P = 0.07). Although there was no significant difference between the 2 groups in RDS rates, more babies in the AM compared with the EM group required oxygen at 24 hours (7.0 vs. 1.6%, P = 0.05). Only delivery at 34 weeks of gestation remained associated with the need for neonatal oxygen at 24 hours following adjustment for gestational age at delivery. The rate of hypoglycemia or hypocalcemia was higher in the AM group (AM: 12.3% vs. EM: 5.6%, P = 0.07). No neonatal deaths occurred. These findings indicate that management of PPROM using a policy of AM, especially at 34 weeks of gestation, is associated with greater neonatal morbidity, and an EM policy with a higher rate of clinical chorioamnionitis. The choice between AM or EM at 34 to 36 weeks of gestation remains controversial.

Active versus expectant management for preterm prelabor rupture of membranes at 34‐36 weeks of completed gestation: comparison of maternal and neonatal outcomes

To compare maternal and neonatal outcomes in deliveries managed by a policy of expectant management and active management of women with preterm prelabor rupture of membranes (pPROM), at 34-36 completed weeks of gestation. Retrospective multicenter cohort study. Three tertiary care teaching hospitals in France. Women with pPROM were identified from the databases of three perinatal centers. Maternal and neonatal complications were compared according to the hospital policy in effect at pPROM--expectant or active management. Clinical chorioamnionitis, neonatal morbidity including neonatal infection, respiratory problems, and metabolic disorders. During the seven-year study period, 634 women were admitted for pPROM at 34-36 completed weeks of gestation, 241 of whom were included in the study: 126 in the group with a policy of expectant management and 115 in the active management group. The incidence of clinical chorioamnionitis was 4.8% in the former and 0.9% in the latter (p = 0.07). Neonatal oxygen was still needed at 24 hours significantly more often in the active than in the expectant management group (7.0 vs. 1.6%, p = 0.05). However, after adjustment for gestational age at birth, only delivery at 34 weeks of gestation remained associated with the need for neonatal oxygen at 24 hours. The rate of hypoglycemia or hypocalcemia was 5.6% in the expectant management group versus 12.3% in the active management group (p = 0.07). There were no neonatal deaths. A policy of active management, especially at 34 weeks of gestation, was associated with greater neonatal morbidity, whereas an expectant management policy tended to be associated with an increased rate of clinical chorioamnionitis.

Perinatal outcome after preterm premature rupture of membranes with in situ cervical cerclage

Objective: The presence of a cervical cerclage at the time of preterm premature rupture of membranes (pPROM) could promote clinically evident infection and adverse pregnancy outcome. This cohort study examines whether the presence of cerclage at the time of pPROM is associated with increased maternal or neonatal inflammatory morbidity. Study Design: All singleton pregnancies with cerclage and pPROM between 24.0 and 33.9 weeks' gestation at our institution (January 1985-December 1997) were reviewed. Controls (pPROM without cerclage) were matched 2.5:1 by year of presentation. Outcome measures suggest clinical evidence of an infectious response and include maternal admission white blood cell count, time to onset of preterm labor, clinical chorioamnionitis, postpartum fever, neonatal white-matter disease (intraventricular hemorrhage or periventricular leukomalacia) at less than 33 weeks, neonatal sepsis, and neonatal death. Results: One hundred fourteen cases of pPROM and cerclage were matched with 288 controls. The study had power (α =.05, power = 0.8) to detect a two-fold difference in incidence of adverse neonatal outcome. Among the mothers, the incidence of clinical chorioamnionitis (14.0% vs 18.8%, P =.26), uterine activity at admission (33.3% vs 32.2%, P =.44), maternal postpartum fever (7.9% vs 7.6%, P =.93) in cerclage versus no cerclage were equivalent. Among the neonates, the incidence of neonatal white-matter disease (15.3% vs 13.7%, P =.75), neonatal sepsis (9.1% vs 6.0%, P =.21), and neonatal death were similar. Conclusion: Rates of maternal and neonatal morbidity were similar between both groups. The close overall similarity between the groups strongly suggest clinically insignificant differences between the two groups. These data indicate that a cervical cerclage at the time of pPROM less than 34 weeks does not adversely affect pregnancy outcome. (Am J Obstet Gynecol 2002;187:1147-52.)

Meconium aspiration syndrome in term neonates with normal acid-base status at delivery: Is it different?

Objective: Our aim was to compare the clinical characteristics of meconium aspiration syndrome in cases with pH ≥7.20 and in those with pH <7.20. Study Design: Medical records of diagnostic codes from the International Classification of Diseases, Ninth Revision, were used to identify neonates with severe meconium aspiration syndrome who had been delivered at our institution from 1994 through 1998. Severe meconium aspiration syndrome was defined as a mechanical ventilator requirement of >48 hours. Clinical data including neonatal outcomes of cases of meconium aspiration syndrome associated with umbilical pH ≥7.20 at delivery were compared with data on outcomes of cases with pH <7.20. Results: During this 4-year study period, 4985 singleton term neonates were delivered through meconium-stained amniotic fluid. Forty-eight cases met all study criteria, and pH values at delivery were as follows: pH ≥7.20, n = 29, and pH <7.20, n = 19. There were no differences between groups in the incidence of clinical chorioamnionitis, in the presence of meconium below the vocal cords, or in birth weight. Neonates with meconium aspiration syndrome and umbilical pH ≥7.20 at delivery developed seizures as often as those with pH <7.20 (20.1% vs 21.1%; P = 1.0). Conclusion: Normal acid-base status at delivery is present in many cases of severe meconium aspiration syndrome, which suggests that either a preexisting injury or a nonhypoxic mechanism is often involved. (Am J Obstet Gynecol 2001;184:1422-6.)

Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements.

The objective of this study was to assess the relationship between amniotic fluid volume (AFV) and fetal movements at < 32 weeks gestation as assessed by routine biophysical profile (BPP). From a database of 465 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with AFV and fetal movements determined as part of a BPP assessment within 24 hours of delivery were studied. Amniotic fluid volume was scored 0 to 2, according to the following criteria: largest pocket in vertical diameter < 1 cm = 0; < 2 but > 1 cm = 1; > or = 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: 0 if absent, 1 if 1 to 2 movements, 2 if > or = 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestational age (GA), premature rupture of membranes (PROM) as a principal indication for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion and umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had PROM as a primary indication for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematurity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation between decreased AFV and decreased fetal movements (p < 0.0001). Fetal presentation and GA were not significantly different between patients based on score of fetal movements. The incidence of clinical chorioamnionitis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movements irrespective of fetal presentation or gestational age. Neonatal outcome (umbilical vasculitis, sepsis, intraventricular hemorrhage) is affected only in unusual cases in which otherwise uncompromised (nonhypoxic, nonacidotic) fetuses have low scores on both these antepartum ultrasonographic parameters.