Dataset Information

Suspected clinical chorioamnionitis with peak intrapartum temperature <38⁰C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

ABSTRACT:

Background

Chorioamnionitis (CA) affects up to 3.9% of all deliveries worldwide and is one of the leading causes of early-onset neonatal sepsis. Fever≥38⁰C is an essential criterion for the diagnosis of clinical CA. Obstetricians frequently take the maternal risk factors into consideration, and many mothers are treated as CA even with peak intrapartum temperature (PIT) between 37.6⁰C to 37.9⁰C if they have other clinical signs and risk factors.

Aim

To estimate the prevalence of confirmed chorioamnionitis and adverse neonatal outcomes among those mothers with PIT below 38⁰C.

Materials and methods

Retrospective chart review among mothers delivered at Al-Wakra Hospital, Qatar, between1^stJanuary2016 to 31^stDecember 2019 with a clinical suspicion of CA.

Results

Among 21,471 mothers, 442 were suspected of having CA (2.06%, 95% CI 1.88 to 2.26%). After exclusions, 415 were included in the study, 203(48.9%) mothers had PIT between 37.6-37.9⁰C. There was no significant difference in the rate of confirmed CA between the low (<38⁰C) and higher (≥38⁰C) temperature groups (25.4%Vs.31.3%, OR0.75, 95%CI0.46-1.25 , p.262). More patients in the low-temperature group received paracetamol for PIT between 37.6 to 37.9 ⁰C, while it was less frequently used for such milder elevation in higher temperature group (88.2%Vs.38.9%, OR11.69, 95% CI 6.46-2.15, p <.001).

Conclusion

The incidence of suspected clinical CA in our institution was within the international rates. Although nearly half of the mothers with suspected clinical CA had peak temperature below the recommended diagnostic criteria, the rate of confirmed CA and neonatal outcome was not significantly different from those with PIT≥38⁰C. Early antipyretic use might have affected further elevation of temperature.

SUBMITTER: Vellamgot AP

PROVIDER: S-EPMC8996607 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Suspected clinical chorioamnionitis with peak intrapartum temperature <38<sup>0</sup>C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Vellamgot Anvar Paraparambil AP Salameh Khalil K Habboub Lina Hussain M LHM Pattuvalappil Rajesh R Elkabir Naser Abulgasim NA Siam Yousra Shehada YS Khatib Hakam H

BMC pediatrics 20220411 1

<h4>Background</h4>Chorioamnionitis (CA) affects up to 3.9% of all deliveries worldwide and is one of the leading causes of early-onset neonatal sepsis. Fever≥38<sup>0</sup>C is an essential criterion for the diagnosis of clinical CA. Obstetricians frequently take the maternal risk factors into consideration, and many mothers are treated as CA even with peak intrapartum temperature (PIT) between 37.6<sup>0</sup>C to 37.9<sup>0</sup>C if they have other clinical signs and risk factors.<h4>Aim</h4 ...[more]

PMID: 35410259

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Project description:Background: Elevated intrapartum temperature has been widely proven to be associated with adverse clinical outcomes in both mothers and neonates. Histological chorioamnionitis (HCA), the inflammation of chorion and amniotic membranes, is commonly observed in those with elevated intrapartum temperature. Thus, we aimed to explore whether the combination of HCA would further affect the pregnancy outcomes in those with intrapartum temperature ≥ 37.5°C. Methods: This retrospective cohort study was conducted at the International Peace Maternity and Child Health Hospital (IPMCH), including all full-term women with intrapartum temperature ≥ 37.5°C from Jan 2017 to Jan 2019. Patients were divided in to HCA group or control group according to placental pathology results, and we used 1:1 propensity score matching (PSM) to reduce the effects of potential confounding factors between the two groups. Univariate and multivariable logistic regression were used to identify the association between HCA and different adverse maternal and neonatal outcomes. Results: We formed a propensity-score matched cohort containing 464 women in each group. Higher positive rate of mycoplasma (14.01% vs. 7.33%, p = 0.001) was found in the vaginal secretion culture of women in the HCA group. After adjusting for various baseline clinical characteristics, women with HCA were more likely to end their delivery by cesarean section (AOR = 1.55, 95% CI: 1.05-2.28), and puerperal morbidity (AOR = 2.77, 95% CI: 1.44-5.33) as well as prolonged hospitalization (AOR = 1.56, 95% CI: 1.12-2.17) were more likely to be observed in the HCA group. The existence of HCA might also be associated with neonatal sepsis (AOR = 2.83, 95% CI: 1.14-7.04) and NICU admission (AOR = 1.40, 95% CI: 1.04-1.87) in newborns. In the study on the impact of different stages of HCA, we found that both maternal and neonatal outcomes would not be affected by mild HCA (stage I), while HCA of stage III was associated with increased need for neonatal respiratory support and elevated likelihood of prolonged hospitalization in neonates. Conclusions: Elevated intrapartum temperature complicated by HCA might be related to the elevated occurrence of several adverse maternal and neonatal outcomes, except those with HCA of stage I. Advanced HCA stage correlated with a worse prognosis.

Project description:BackgroundThe impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.MethodsSingleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.ResultsAfter chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5-13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1-18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.ConclusionsThe rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.

Dataset Information

Suspected clinical chorioamnionitis with peak intrapartum temperature <38⁰C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Background

Aim

Materials and methods

Results

Conclusion

Publications

Suspected clinical chorioamnionitis with peak intrapartum temperature <38<sup>0</sup>C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Suspected clinical chorioamnionitis with peak intrapartum temperature <380C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Background

Aim

Materials and methods

Results

Conclusion

Publications

Suspected clinical chorioamnionitis with peak intrapartum temperature <38<sup>0</sup>C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Suspected clinical chorioamnionitis with peak intrapartum temperature <38⁰C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.