Abstract
Objectives
To compare characteristics of labor, cardiotocography traces, and maternal and neonatal outcomes, in a cohort of pregnancies at term complicated by maternal intrapartum pyrexia, with or without a histologic diagnosis of chorioamnionitis.
Methods
This is a retrospective case-control study including pregnancies at term with detection of maternal intrapartum pyrexia, delivered between January 2020 and June 2021. Cardiotocography traces were entirely evaluated, since admission till delivery, and classified according to the International Federation of Obstetrics and Gynecology (FIGO) guideline. Maternal and neonatal outcomes were also recorded as secondary outcomes. Placentas have been studied according to the Amniotic Fluid Infection Nosology Committee.
Results
Forty four patients met the inclusion criteria and were included in the study cohort. There was a significant association between the use of oxytocin augmentation in labor and the histologic diagnosis of chorioamnionitis. A significative recurrence of loss and/or absence of accelerations at the point of pyrexia was also documented in women with histological chorioamnionitis compared to the others.
Conclusions
Chorioamnionitis appears to be associated with myometrial disfunction, as suggested by the increased use of oxytocin augmentation during active labor of women at term with intrapartum pyrexia and histologic diagnosis of chorioamnionitis.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The raw data can be obtained on request from the corresponding author.
References
1. Menon, R, Taylor, RN, Fortunato, SJ. Chorioamnionitis – a complex pathophysiologic syndrome. Placenta 2010;31:113–20. https://doi.org/10.1016/j.placenta.2009.11.012.Search in Google Scholar PubMed
2. Monif, GRG, Baker, DA, editors. Infectious diseases in obstetrics and gynecology, 5th ed. London: Parthenon; 2004.Search in Google Scholar
3. Tita, ATN, Andrews, WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010;37:339–54. https://doi.org/10.1016/j.clp.2010.02.003.Search in Google Scholar PubMed PubMed Central
4. Ericson, JE, Laughon, MM. Chorioamnionitis: implications for the neonate. Clin Perinatol 2015;42:155–65. https://doi.org/10.1016/j.clp.2014.10.011.Search in Google Scholar PubMed PubMed Central
5. Shatrov, JG, Birch, SCM, Lam, LT, Quinlivan, JA, McIntyre, S, Mendz, GL. Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol 2010;116:387–92. https://doi.org/10.1097/aog.0b013e3181e90046.Search in Google Scholar PubMed
6. Oskoui, M, Coutinho, F, Dykeman, J, Jetté, N, Pringsheim, T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013;55:509–19. https://doi.org/10.1111/dmcn.12080.Search in Google Scholar PubMed
7. Soper, DE, Mayhall, CG, Dalton, HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol 1989;161:562–8. https://doi.org/10.1016/0002-9378(89)90356-6.Search in Google Scholar PubMed
8. Tran, SH, Caughey, AB, Musci, TJ. Meconium-stained amniotic fluid is associated with puerperal infections. Am J Obstet Gynecol 2003;189:746–50. https://doi.org/10.1067/s0002-9378(03)00767-1.Search in Google Scholar PubMed
9. ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 80: premature rupture of membranes. Obstet Gynecol 2007;109:1007–19. https://doi.org/10.1097/01.AOG.0000263888.69178.1f.Search in Google Scholar PubMed
10. Wu, YW, Colford, JM. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. J Am Med Assoc 2000;284:1417–24. https://doi.org/10.1001/jama.284.11.1417.Search in Google Scholar PubMed
11. Gibbs, RS, Blanco, JD, St Clair, PJ, Castaneda, YS. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis 1982;145:1–8. https://doi.org/10.1093/infdis/145.1.1.Search in Google Scholar PubMed
12. Dong, Y, Clazr, PJS, Ramzy, Z, Kagan-Hallet, KS, Gibbs, RS. A microbiologic and clinical study of placental inflammation at term. Obstet Gynecol 1987;70:175–82.Search in Google Scholar
13. Smulian, JC, Shen-Schwarz, S, Vintzileos, AM, Lake, MF, Ananth, CV. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol 1999;94:1000–5. https://doi.org/10.1016/s0029-7844(99)00416-0.Search in Google Scholar PubMed
14. Sukumaran, S, Pereira, V, Mallur, S, Chandraharan, E. Cardiotocograph (CTG) changes and maternal and neonatal outcomes in chorioamnionitis and/or funisitis confirmed on histopathology. Eur J Obstet Gynecol Reprod Biol 2021;260:183–8. https://doi.org/10.1016/j.ejogrb.2021.03.029.Search in Google Scholar PubMed
15. Chandraharan, E. Handbook of CTG interpretation. From patterns to physiology. Cambridge: Cambridge University Press; 2017:71–7 pp.10.1017/9781316161715Search in Google Scholar
16. Ayres-de-Campos, D, Spong, CY, Chandraharan, E; FIGO intrapartum fetal monitoring expert consensus panel. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet 2015;131:13–24. https://doi.org/10.1016/j.ijgo.2015.06.020.Search in Google Scholar PubMed
17. Redline, RW, Faye-Petersen, O, Heller, D, Qureshi, F, Savell, V, Vogler, C. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol 2003;6:435–48. https://doi.org/10.1007/s10024-003-7070-y.Search in Google Scholar PubMed
18. Cierny, JT, Unal, ER, Flood, P, Rhee, KY, Praktish, A, Olson, TH, et al.. Maternal inflammatory markers and term labor performance. Am J Obstet Gynecol 2014;210:447. https://doi.org/10.1016/j.ajog.2013.11.038.Search in Google Scholar PubMed
19. Duff, P, Sanders, R, Gibbs, RS. The course of labor in term patients with chorioamnionitis. Am J Obstet Gynecol 1983;147:391–5. https://doi.org/10.1016/s0002-9378(16)32231-1.Search in Google Scholar PubMed
20. Zackler, A, Flood, P, Dajao, R, Maramara, L, Goetzl, L. Suspected chorioamnionitis and myometrial contractility: mechanisms for increased risk of cesarean delivery and postpartum hemorrhage. Reprod Sci 2019;26:178–83. https://doi.org/10.1177/1933719118778819.Search in Google Scholar PubMed
21. Galli, L, Dall’Asta, A, Whelehan, V, Archer, A, Chandraharan, E. Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses. J Obstet Gynaecol Res 2019;45:2343–50. https://doi.org/10.1111/jog.14133.Search in Google Scholar PubMed
22. Hoffman, MK. Chorioamnionitis: a reason to deliver but not perform a caesarean. BJOG An Int J Obstet Gynaecol 2019;126:728. https://doi.org/10.1111/1471-0528.15602.Search in Google Scholar PubMed
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