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Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes.

Publication ,  Journal Article
Ajayi, SO; Morris, J; Aleem, S; Pease, ME; Wang, A; Mowes, A; Welles, SL; Anday, EK; Bhandari, V
Published in: J Matern Fetal Neonatal Med
December 2022

BACKGROUND: Chorioamnionitis is a risk factor for fetal and neonatal outcomes. Therefore, predicting histological chorioamnionitis (HCA) and neonatal outcomes using clinical parameters could be helpful in management and preventing morbidities. OBJECTIVE: To determine if parameters of clinical chorioamnionitis (CCA) would be associated with HCA and neonatal outcomes. STUDY DESIGN: In this cohort study using a retrospective design, we analyzed the performance of signs of CCA in predicting HCA, and neonatal outcomes. Data were extracted from the electronic health record for all neonates with documented CCA delivered at our institution from 2011 to 2016. We compared our findings based on the old ACOG definition of CCA and the new definition released in 2017 - maternal fever plus any of fetal tachycardia, maternal leukocytosis, and purulent vaginal discharge. Maternal tachycardia and uterine tenderness were removed from the new criteria. Neonatal laboratory samples on admission, 12 h and 24 h were used to define the three time points of neonatal suspected sepsis. RESULTS: There were 530 mothers-infant dyads with chorioamnionitis. Seventy-three were preterm, and 457 were term. Eighty-eight percent of the preterm mothers had CCA, and HCA was present in 62.5% of 72 preterm placentas. Preterm infants with placental HCA significantly had lower birth weight, gestational age, placental weight, and more infants with lower 5-minute Apgar scores, compared to those with no HCA. In preterm infants, maternal urinary tract infection was significantly associated with decreased odds for HCA (OR 0.22, CI 0.10 - 0.71). More preterm babies with suspected sepsis criteria at the 3 time points had HCA (all p ≤ .01). In the term cohort, 95.4% and 65.6% had CCA and HCA, respectively. In term infants (n = 457), maternal leukocytosis (p = .002) and prolonged rupture of membranes (PROM; p = 002) were associated with HCA. Suspected sepsis was associated with PROM (p = .04), HCA (p = .0001), and maternal leukocytosis (p ≤ .05) in at least 1 of the 3 time points. CONCLUSION: Though maternal leukocytosis was significantly associated with the presence of HCA in the term cohort, there were no CCA criteria that accurately predicted presence of HCA in either the preterm or the term infants.

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Published In

J Matern Fetal Neonatal Med

DOI

EISSN

1476-4954

Publication Date

December 2022

Volume

35

Issue

26

Start / End Page

10337 / 10347

Location

England

Related Subject Headings

  • Sepsis
  • Retrospective Studies
  • Pregnancy
  • Placenta
  • Obstetrics & Reproductive Medicine
  • Leukocytosis
  • Infant, Premature
  • Infant, Newborn
  • Infant
  • Humans
 

Citation

APA
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ICMJE
MLA
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Ajayi, S. O., Morris, J., Aleem, S., Pease, M. E., Wang, A., Mowes, A., … Bhandari, V. (2022). Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes. J Matern Fetal Neonatal Med, 35(26), 10337–10347. https://doi.org/10.1080/14767058.2022.2128648
Ajayi, Samuel O., James Morris, Samia Aleem, Mary E. Pease, Anqi Wang, Anja Mowes, Seth L. Welles, Endla K. Anday, and Vineet Bhandari. “Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes.J Matern Fetal Neonatal Med 35, no. 26 (December 2022): 10337–47. https://doi.org/10.1080/14767058.2022.2128648.
Ajayi SO, Morris J, Aleem S, Pease ME, Wang A, Mowes A, et al. Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes. J Matern Fetal Neonatal Med. 2022 Dec;35(26):10337–47.
Ajayi, Samuel O., et al. “Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes.J Matern Fetal Neonatal Med, vol. 35, no. 26, Dec. 2022, pp. 10337–47. Pubmed, doi:10.1080/14767058.2022.2128648.
Ajayi SO, Morris J, Aleem S, Pease ME, Wang A, Mowes A, Welles SL, Anday EK, Bhandari V. Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes. J Matern Fetal Neonatal Med. 2022 Dec;35(26):10337–10347.

Published In

J Matern Fetal Neonatal Med

DOI

EISSN

1476-4954

Publication Date

December 2022

Volume

35

Issue

26

Start / End Page

10337 / 10347

Location

England

Related Subject Headings

  • Sepsis
  • Retrospective Studies
  • Pregnancy
  • Placenta
  • Obstetrics & Reproductive Medicine
  • Leukocytosis
  • Infant, Premature
  • Infant, Newborn
  • Infant
  • Humans