476: Association of clinical chorioamnionitis with histological evidence of maternal or fetal inflammatory response

Aziz, Fátima; Salafia, Carolyn M.; Rothschild, Tod; Akinnawonu, Felix; Fuks, Aleksandr

doi:10.1016/j.ajog.2013.10.509

Cited by 3 publications

(1 citation statement)

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“…Poor correlation between CC and HC has been reported previously. 11,24,25 New methods of reliable diagnosis of CC are necessary to further reduce the use of antibiotics in labor and subsequent neonatal ICU admission and intervention rate.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study

Spenard

Tordjman

Marrié-Mas

et al. 2022

Intl J Gynecology & Obste

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Objective: To assess the impact of a quality-improvement initiative designed to increase diagnostic accuracy and adequate management of clinical chorioamnionitis (CC) at a tertiary center. Chorioamnionitis occurs in 1%-13% of term pregnancies and increases maternal and neonatal peripartum complications; often over-diagnosed, it leads to unnecessary investigations and treatments. Methods: This was an interrupted time-series study. In September 2017 two interventions were implemented: (1) staff training and (2) standardized clinical protocol for the management of fever in labor. All singleton term pregnancies were included. CC cases were reviewed in the pre-intervention (2015-2016, n = 179) and postintervention (2017-2018, n = 142) groups. CC criteria based on the American College of Obstetricians and Gynecologists guidelines, antibiotics, maternal and neonatal outcomes, and pathology were compared. A cost-consequence analysis was performed.Results: Incidence of CC decreased from 8.2 to 5.6 per 10 person-year (P < 0.001).This was associated with a significant increase in diagnostic accuracy from 15.7% to 73.2% (P < 0.001). Weight-adjusted tobramycin dosage improved from 8.8% to 69.1% (P < 0.001). Maternal length of hospitalization and readmissions decreased significantly, without affecting neonatal sepsis rate. Interventions decreased yearly hospital costs associated with CC by 23.4%. Conclusion:Standardizing the management of fever in labor significantly increased the diagnostic accuracy of CC and decreased the misuse of antibiotics in term pregnancies. CC costs decreased by 23.4%.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study

Spenard

Tordjman

Marrié-Mas

et al. 2022

Intl J Gynecology & Obste

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Implementation of an EOS calculator-based protocol decreased infant antibiotic exposure in chorioamnionitis without correlation with placental histopathology

Robinson,

Knott,

Liu

et al. 2024

J Perinatol

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Association of Clinical Signs of Chorioamnionitis with Histological Chorioamnionitis and Neonatal Outcomes in Women with Premature Rupture of Membranes

Asogwa,

Ezugwu,

Eleje

et al. 2023

Nigerian Journal of Clinical Practice

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Background: Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications. Aim: The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM. Materials and Methods: Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb’s criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically. Results: Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM. Conclusion: Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

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476: Association of clinical chorioamnionitis with histological evidence of maternal or fetal inflammatory response

Cited by 3 publications

References 0 publications

Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study

Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study

Implementation of an EOS calculator-based protocol decreased infant antibiotic exposure in chorioamnionitis without correlation with placental histopathology

Association of Clinical Signs of Chorioamnionitis with Histological Chorioamnionitis and Neonatal Outcomes in Women with Premature Rupture of Membranes

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