Discussion Questions

• ■
  

  Why is this study question important?

  
  
• ■
  

  What is your opinion of the dataset?

  
  
• ■
  

  Were inclusion and exclusion criteria clearly described?

  
  
• ■
  

  Why employ 4 unexposed subjects for each exposed subject?

  
  
• ■
  

  What information is contained in the tables?

  
  
• ■
  

  What can we take away from this study?

Introduction

Chorioamnionitis complicates pregnancy, though severe problems are uncommon among women who receive timely antibiotics. Even so, some 10% can develop bacteremia, and risks for postpartum hemorrhage, cesarean section, and surgical complications rise. Infants are at greater peril because their odds for consequences like cerebral palsy (CP), neonatal sepsis, or pneumonia climb. For example, chorioamnionitis boosts the incidence of CP from 3/1000 to 8/1000 live term births. When the membranes rupture before 37 weeks’ gestation, neonates exposed to infection and inflammation have more than 3 times the mortality rate of those who are not. A new study indicates that an episode makes women more susceptible to recurrence.

George A. Macones, MD, MSCE, Associate Editor

Introduction

Chorioamnionitis complicates pregnancy, though severe problems are uncommon among women who receive timely antibiotics. Even so, some 10% can develop bacteremia, and risks for postpartum hemorrhage, cesarean section, and surgical complications rise. Infants are at greater peril because their odds for consequences like cerebral palsy (CP), neonatal sepsis, or pneumonia climb. For example, chorioamnionitis boosts the incidence of CP from 3/1000 to 8/1000 live term births. When the membranes rupture before 37 weeks’ gestation, neonates exposed to infection and inflammation have more than 3 times the mortality rate of those who are not. A new study indicates that an episode makes women more susceptible to recurrence.

George A. Macones, MD, MSCE, Associate Editor

Background

Macones: Thank you for joining this discussion of a new paper on the risk of recurrent chorioamnionitis. What did you think of this research question?

Cahill: I liked it. First, there has not been very much work on this topic in the past. Second, chorioamnionitis is associated with important adverse outcomes for the infant—essentially, preterm birth, CP, neonatal sepsis, and pneumonia. Thus, furthering our understanding of risk factors for these outcomes may lead to biologically-driven treatments in the future. I also liked that this question had clinical and biologic aspects.