Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality-improvement study.
clinical chorioamnionitis
fever in labor
intra-amniotic infection
intrapartum antibiotics
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
revised:
02
09
2022
received:
24
05
2022
accepted:
25
09
2022
pubmed:
2
10
2022
medline:
17
3
2023
entrez:
1
10
2022
Statut:
ppublish
Résumé
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. 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 post-intervention (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. 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%. 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%.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
225-233Subventions
Organisme : Canadian Institutes for Health Research
Informations de copyright
© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Références
Tita A, Andrews W. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37(2):339-354.
Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991;164(5 Pt 1):1317-1326.
Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors for intra-amniotic infection. Obstet Gynecol. 1989;73(4):571-575.
Money D, Allen V. Society of Obstetrics and Gynecology of Canada. The prevention of early-onset neonatal group B streptococcal disease. J Obstet Gynaecol Can. 2013;35(10):939-951.
Jefferies A, Canadian Paediatric Society. Management of term infants at increased risk for early onset bacterial sepsis. Paediatr Child Health. 2017;22(4):223-228.
Weston EJ, Pondo T, Lewis MM, et al. The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008. Pediatr Infect Dis J. 2011;30(11):937-941.
Jackson G, Rawiki P, Sendelbach D, Manning M, Engle W. Hospital course and short-term outcomes of term and late preterm neonates following exposure to prolonged rupture of membranes and/or chorioamnionitis. Pediatr Infect Dis J. 2012;31(1):89-90.
Higgins RD, Saade G, Polin RA, et al. Evaluation and Management of Women and Newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol. 2016;127(3):426-436.
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):1-8.
Sung JH, Choi SJ, Oh SY, Roh CR. Should the diagnostic criteria for suspected clinical chorioamnionitis be changed? J Matern Fetal Neonatal Med. 2019;34:1-10.
Curtin WM, Katzman PJ, Florescue H, Metlay LA. Accuracy of signs of clinical chorioamnionitis in the term parturient. J Perinatol. 2013;33(6):422-428.
Romero R, Miranda J, Kusanovic JP, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015;43(1):19-36.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Langley GLMR, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. Jossey-Bass Publishers; 2009.
Black LP, Hinson L, Duff P. Limited course of antibiotic treatment for chorioamnionitis. Obstet Gynecol. 2012;119(6):1102-1105.
Edwards RK, Duff P. Single additional dose postpartum therapy for women with chorioamnionitis. Obstet Gynecol. 2003;102(5 Pt 1):957-961.
Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol. 1993;36(4):795-808.
Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140(7):698-713.
Jacobs PBA, Lee KM. Guidance document for the costing of health care resources in the Canadian setting, [CADTH Website] 2016. https://www.cadth.ca/sites/default/files/pdf/CP0009_CADTHCostingGuidance.pdf. Accessed May 13th 2022.
Charpentier C, McDonald S, Elwood C, et al. A survey on variation in diagnosis and treatment of chorioamnionitis in tertiary Centres in Canada. J Obstet Gynaecol Can. 2021;4(1):28-33.
Greenberg MB, Anderson BL, Schulkin J, Norton ME, Aziz N. A first look at chorioamnionitis management practice variation among US obstetricians. Infect Dis Obstet Gynecol. 2012;2012:628362.
Chiruvolu A, Petrey B, Stanzo KC, Daoud Y. An institutional approach to the Management of Asymptomatic Chorioamnionitis-Exposed Infants Born >/=35 weeks gestation. Pediatr Qual Saf. 2019;4(6):e238.
Joshi NS, Gupta A, Allan JM, et al. Management of chorioamnionitis-exposed infants in the newborn nursery using a clinical examination-based approach. Hosp Pediatr. 2019;9(4):227-233.
Aziz F, Salafia C, Rothschild T, Akinnawonu F, Fuks A. 476: Association of clinical chorioamnionitis with histological evidence of maternal or fetal inflammatory response. Am J Obstet Gynecol. 2014;210(1):S238.
Suzuki S. Association between clinical chorioamnionitis and histological funisitis at term. J Neonatal Perinatal Med. 2019;12(1):37-40.