831 Are we triaging effectively? likelihood of preterm delivery following triage discharge versus antepartum admission

Abstract

OBJECTIVE: Intrauterine Pressure Catheters (IUPC) are thought to create a pathway for contamination and ascending infections. We sought to estimate the risk of chorioamnionitis associated with IUPC use in term labor. STUDY DESIGN: This is a retrospective cohort study of term (37 weeks), singleton pregnancies who labored at our tertiary care center from 2005 to 2018. The primary outcome of chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39 C or 38e38.9 C for 30 minutes) and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the presence of an IUPC documented in the medical record. Cox proportional hazard regression was used to model the effect of cervical examinations on the risk of chorioamnionitis while adjusting for adjusted for number of cervical exams, epidural use, meconium, smoking, GBS, parity, BMI, duration of rupture, labor induction and cesarean section. RESULTS: 20,579 women met inclusion criteria and1,039 (5%) women were diagnosed with chorioamnionitis. Of the subjects diagnosed with chorioamnionitis, 185 (17.8%) had IUPCs compared to 22.5% in women not diagnosed with infection (p<0.001). IUPCs were not associated with increased rate of chorioamnionitis after adjusting for potential confounders (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.5-0.7; p¼<0.001). Presence of IUPCs was higher in women undergoing unplanned cesarean delivery (30.6% versus 21.1% in women undergoing vaginal delivery, p¼<0.001). Meconium rates were not higher in women with IUPCs (IUPC 20.0% versus no IUPC18.8 p¼0.06) CONCLUSION: In contrast to prior work, routine use of internal monitoring in laboring patient did not increase the risk of chorioamnionitis. Internal monitors should not be avoided during term labor management.