Chorioamnionitis versus intraamniotic infection among preterm deliveries—is postpartum infectious morbidity different?

• Published in: American journal of obstetrics & gynecology MFM 2020-08, Vol.2 (3), p.100176-100176, Article 100176
• Main Authors: Denoble, Anna E., Wu, Jenny, Mitchell, Courtney J., Hughes, Brenna L., Dotters-Katz, Sarah K.
• Format: Article
• Language: English
• Subjects: BEAM; chorioamnionitis; endometritis; infectious disease; intraamniotic infection; intrauterine infection; intrauterine inflammation; postpartum complications; preterm; Triple I
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2020.100176

Chorioamnionitis can have a highly variable definition with substantial maternal and fetal morbidity, with higher frequencies in preterm births. With the recently updated intraamniotic infection diagnostic criteria by the American College of Obstetricians and Gynecologists, fewer women experiencing preterm delivery may qualify for intrapartum antibiotic treatment, potentially resulting in higher postpartum infectious morbidity. This study aimed to estimate whether the proportion of women delivering preterm who develop postpartum endometritis differs between subjects diagnosed as having clinical chorioamnionitis and those meeting the American College of Obstetricians and Gynecologists’ criteria for intraamniotic infection. Secondary analysis was conducted using a randomized controlled trial of antenatal magnesium sulfate for the prevention of cerebral palsy. Subjects were included if they had a clinical diagnosis of chorioamnionitis and maternal temperature of ≥37.8°C and excluded if maternal temperature data were missing. The exposure group included women who met the criteria for intraamniotic infection, defined as a single maternal temperature of ≥39.0°C or maternal temperature of 38.0°C to 38.9°C plus 1 additional clinical risk factor (leukocytosis, purulent cervical drainage, or fetal tachycardia). The primary outcome was postpartum endometritis. The odds of postpartum endometritis were compared between women with intraamniotic infection and women with clinical chorioamnionitis, after adjusting for potential confounders using multivariate logistic regression. Of the original study population, 258 of 2241 (11.8%) subjects met the criteria for chorioamnionitis. Nearly all subjects (98.5%) received antibiotic treatment between randomization and delivery. A total of 144 subjects (55.8%) met the criteria for intraamniotic infection, whereas 114 (44%) only met the criteria for clinical chorioamnionitis. A total of 40 women (15.5%) experienced postpartum endometritis. Women with intraamniotic infection had higher parity (P=.02) and higher maximum maternal temperature (P