Objectives
The clinical diagnosis of chorioamnionitis requires a high index of suspicion. Unrecognized and untreated chorioamnionitis can lead to poor maternal and neonatal outcomes. Recent study of the concordance between clinical and histologic diagnosis and the impact made by treating is limited. We sought to examine women with histologic chorioamnionitis and assess rates of clinical detection and intrapartum and neonatal outcomes.
Methods
After obtaining IRB approval, a single center, retrospective chart review of all histologic chorioamnionitis occurring in a singleton gestation, with active labor, at ≥ 37 weeks from January 1, 2014 – June 30, 2014 was conducted. Multiple gestations, known fetal anomalies, and women with preterm premature rupture of membranes were excluded as were women with cerclage placed in the current pregnancy. Among women meeting criteria, charts were reviewed for clinical diagnosis of infection, demographic, prenatal, and intrapartum characteristics. Data were analyzed by t test, chi-square, and Fisher’s exact where appropriate.
Methods
After obtaining IRB approval, a single center, retrospective chart review of all histologic chorioamnionitis occurring in a singleton gestation, with active labor, at ≥ 37 weeks from January 1, 2014 – June 30, 2014 was conducted. Multiple gestations, known fetal anomalies, and women with preterm premature rupture of membranes were excluded as were women with cerclage placed in the current pregnancy. Among women meeting criteria, charts were reviewed for clinical diagnosis of infection, demographic, prenatal, and intrapartum characteristics. Data were analyzed by t test, chi-square, and Fisher’s exact where appropriate.
Results
Seventy-four women with histologically confirmed chorioamnionitis were identified with mean age of 27.4 years, non caucasian race (55.4%), nulliparity (58.1%) at mean gestation of 39.4 weeks. Half of women had a clinical diagnosis of chorioamnionitis (n=39, 52.7%). The majority of these women were diagnosed by maternal fever (n=34; 89%), or tachycardia (n=11, 28.9%) with none having uterine tenderness. Nearly all patients received intrapartum antibiotics prior to delivery (n= 36; 94.7%). In comparing women with concordantly diagnosed clinical and histologic chorioamnionitis to women without a clinical diagnosis, they had shorter interval from admission to delivery, similar rates of operative delivery; however, with increased intrapartum/postpartum complications. See Table.
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