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Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different?

Publication ,  Journal Article
Denoble, AE; Wu, J; Mitchell, CJ; Hughes, BL; Dotters-Katz, SK
Published in: Am J Obstet Gynecol MFM
August 2020

BACKGROUND: Chorioamnionitis can have a highly variable definition with substantial maternal and fetal morbidity, with higher frequencies in preterm births. With the recently updated intraamniotic infection diagnostic criteria by the American College of Obstetricians and Gynecologists, fewer women experiencing preterm delivery may qualify for intrapartum antibiotic treatment, potentially resulting in higher postpartum infectious morbidity. OBJECTIVE: This study aimed to estimate whether the proportion of women delivering preterm who develop postpartum endometritis differs between subjects diagnosed as having clinical chorioamnionitis and those meeting the American College of Obstetricians and Gynecologists' criteria for intraamniotic infection. STUDY DESIGN: Secondary analysis was conducted using a randomized controlled trial of antenatal magnesium sulfate for the prevention of cerebral palsy. Subjects were included if they had a clinical diagnosis of chorioamnionitis and maternal temperature of ≥37.8°C and excluded if maternal temperature data were missing. The exposure group included women who met the criteria for intraamniotic infection, defined as a single maternal temperature of ≥39.0°C or maternal temperature of 38.0°C to 38.9°C plus 1 additional clinical risk factor (leukocytosis, purulent cervical drainage, or fetal tachycardia). The primary outcome was postpartum endometritis. The odds of postpartum endometritis were compared between women with intraamniotic infection and women with clinical chorioamnionitis, after adjusting for potential confounders using multivariate logistic regression. RESULTS: Of the original study population, 258 of 2241 (11.8%) subjects met the criteria for chorioamnionitis. Nearly all subjects (98.5%) received antibiotic treatment between randomization and delivery. A total of 144 subjects (55.8%) met the criteria for intraamniotic infection, whereas 114 (44%) only met the criteria for clinical chorioamnionitis. A total of 40 women (15.5%) experienced postpartum endometritis. Women with intraamniotic infection had higher parity (P=.02) and higher maximum maternal temperature (P<.001) and were more likely to have received antibiotic treatment (P=.04). Postpartum endometritis rates were similar between subjects with chorioamnionitis and intraamniotic infection (12% vs 18%; P=.50). After adjustment for potential confounders, the odds of developing postpartum endometritis did not differ between subjects who met the criteria for intraamniotic infection and those who did not (adjusted odds ratio, 1.28; 95% confidence interval, 0.62-2.62). CONCLUSION: Patients delivering preterm who receive a diagnosis of clinical chorioamnionitis in the intrapartum period seem to have similar odds of developing postpartum endometritis as those meeting the American College of Obstetricians and Gynecologists' criteria for intraamniotic infection, suggesting that this group remains at a high risk for postpartum infectious complications.

Duke Scholars

Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

August 2020

Volume

2

Issue

3

Start / End Page

100176

Location

United States

Related Subject Headings

  • Puerperal Infection
  • Pregnancy
  • Postpartum Period
  • Morbidity
  • Infant, Newborn
  • Humans
  • Female
  • Endometritis
  • Chorioamnionitis
  • 3215 Reproductive medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Denoble, A. E., Wu, J., Mitchell, C. J., Hughes, B. L., & Dotters-Katz, S. K. (2020). Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different? Am J Obstet Gynecol MFM, 2(3), 100176. https://doi.org/10.1016/j.ajogmf.2020.100176
Denoble, Anna E., Jenny Wu, Courtney J. Mitchell, Brenna L. Hughes, and Sarah K. Dotters-Katz. “Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different?Am J Obstet Gynecol MFM 2, no. 3 (August 2020): 100176. https://doi.org/10.1016/j.ajogmf.2020.100176.
Denoble AE, Wu J, Mitchell CJ, Hughes BL, Dotters-Katz SK. Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different? Am J Obstet Gynecol MFM. 2020 Aug;2(3):100176.
Denoble, Anna E., et al. “Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different?Am J Obstet Gynecol MFM, vol. 2, no. 3, Aug. 2020, p. 100176. Pubmed, doi:10.1016/j.ajogmf.2020.100176.
Denoble AE, Wu J, Mitchell CJ, Hughes BL, Dotters-Katz SK. Chorioamnionitis versus intraamniotic infection among preterm deliveries-is postpartum infectious morbidity different? Am J Obstet Gynecol MFM. 2020 Aug;2(3):100176.
Journal cover image

Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

August 2020

Volume

2

Issue

3

Start / End Page

100176

Location

United States

Related Subject Headings

  • Puerperal Infection
  • Pregnancy
  • Postpartum Period
  • Morbidity
  • Infant, Newborn
  • Humans
  • Female
  • Endometritis
  • Chorioamnionitis
  • 3215 Reproductive medicine