Mode of delivery in chorioamnionitis: impact on neonatal and maternal outcomes.
Cesarean delivery
Chorioamnionitis
Early onset neonatal sepsis
Vaginal delivery
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
23 Oct 2024
23 Oct 2024
Historique:
received:
17
03
2024
accepted:
01
10
2024
medline:
24
10
2024
pubmed:
24
10
2024
entrez:
24
10
2024
Statut:
epublish
Résumé
The 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. Singleton 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. After 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. The 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.
Sections du résumé
BACKGROUND
BACKGROUND
The 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.
METHODS
METHODS
Singleton 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.
RESULTS
RESULTS
After 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.
CONCLUSIONS
CONCLUSIONS
The 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.
Identifiants
pubmed: 39443880
doi: 10.1186/s12884-024-06877-2
pii: 10.1186/s12884-024-06877-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
693Subventions
Organisme : Physicians' Services Incorporated Foundation
ID : R22-43
Informations de copyright
© 2024. The Author(s).
Références
ACOG. Committee Opinion 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017;130(2):e95–101.
doi: 10.1097/AOG.0000000000002236
Woodd SL, Montoya A, Barreix M, Pi L, Calvert C, Rehman AM et al. Incidence of maternal peripartum infection: a systematic review and meta-analysis. PLoS Med. 2019;16(12):e1002984. https://doi.org/10.1371/journal.pmed.1002984
Soraisham AS, Singhal N, McMillan DD, Sauve RS, Lee SK. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol. 2009;200(4):372.e1-372.e6.
doi: 10.1016/j.ajog.2008.11.034
Venkatesh KK, Jackson W, Hughes BL, Laughon MM, Thorp JM, Stamilio DM. Association of chorioamnionitis and its duration with neonatal morbidity and mortality. J Perinatol. 2019;39(5):673–82.
doi: 10.1038/s41372-019-0322-0
pubmed: 30723279
Rouse DJ, Landon M, Leveno KJ, Leindecker S, Varner MW, Caritis SN, et al. The maternal-fetal medicine units cesarean registry: Chorioamnionitis at term and its duration - relationship to outcomes. Am J Obstet Gynecol. 2004;191(1):211–6.
doi: 10.1016/j.ajog.2004.03.003
pubmed: 15295368
Ramsey PS, Lieman JM, Brumfield CG, Carlo W. Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. American Journal of Obstetrics and Gynecology. Mosby Inc.; 2005. pp. 1162–6.
Neufeld MD, Frigon C, Graham AS, Mueller BA. Maternal infection and risk of cerebral palsy in term and preterm infants. J Perinatol. 2005;25(2):108–13.
Pundir J, Coomarasamy A. Bacterial sepsis in pregnancy. Obstet Evidence-based Algorithms. 2016;(64):87–9.
Ona S, Easter SR, Prabhu M, Wilkie G, Tuomala RE, Riley LE et al. Diagnostic validity of the proposed Eunice Kennedy Shriver National Institute of Child Health and Human Development Criteria for intrauterine inflammation or infection. Obstet Gynecol. 2019;133(1):33–9. https://journals.lww.com/00006250-201901000-00007
Sung JH, Choi SJ, Oh SY, Roh CR, Kim JH. Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth. BJOG Int J Obstet Gynaecol. 2017;124(5):775–83.
doi: 10.1111/1471-0528.14176
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128(5).
Grisaru-Granovsky S, Schimmel MS, Granovsky R, Diamant YZ, Samueloff A. Cesarean section is not protective against adverse neurological outcome in survivors of preterm delivery due to overt chorioamnionitis. J Matern Neonatal Med. 2003;13(5):323–7. https://pubmed.ncbi.nlm.nih.gov/12916683/
Ashwal E, Salman L, Tzur Y, Aviram A, Ben-Mayor Bashi T, Yogev Y et al. Intrapartum fever and the risk for perinatal complications–the effect of fever duration and positive cultures. J Matern Neonatal Med. 2018;31(11):1418–25. https://doi.org/10.1080/14767058.2017.1317740
Locatelli A, Vergani P, Ghidini A, Assi F, Bonardi C, Pezzullo JC, et al. Duration of labor and risk of cerebral white-matter damage in very preterm infants who are delivered with intrauterine infection. Am J Obstet Gynecol. 2005;193(3):928–32.
doi: 10.1016/j.ajog.2005.05.063
pubmed: 16157089
Levin G, Rottenstreich A, Tsur A, Shai D, Cahan T, Yoeli R et al. Determinants of adverse neonatal outcome in vaginal deliveries complicated by suspected intraamniotic infection. Arch Gynecol Obstet. 2020;302(6):1345–52. https://doi.org/10.1007/s00404-020-05717-w
Li F, Morgan KL, Zaslavsky AM. Balancing covariates via Propensity score weighting. J Am Stat Assoc. 2018;113(521):390–400.
doi: 10.1080/01621459.2016.1260466
Abdelraheim AR, Gomaa K, Ibrahim EM, Mohammed MM, Khalifa EM, Youssef AM, et al. Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy Childbirth. 2019;19(1):1–7.
doi: 10.1186/s12884-019-2394-4
Dotters-Katz SK, Feldman C, Puechl A, Grotegut CA, Heine RP. Risk factors for post-operative wound infection in the setting of chorioamnionitis and cesarean delivery. J Matern Neonatal Med. 2016;29(10):1541–5. https://doi.org/10.3109/14767058.2015.1058773
Kayiga H, Lester F, Amuge PM, Byamugisha J, Autry AM. Impact of mode of delivery on pregnancy outcomes in women with premature rupture of membranes after 28 weeks of gestation in a low-resource setting: a prospective cohort study. PLoS One. 2018;13(1):1–13. https://doi.org/10.1371/journal.pone.0190388
Venkatesh KK, Glover AV, Vladutiu CJ, Stamilio DM. Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study. BJOG Int J Obstet Gynaecol. 2019;126(6):719–27.
doi: 10.1111/1471-0528.15565
Dexter SC, Malee MP, Pinar H, Hogan JW, Carpenter MW, Vohr BR. Influence of chorioamnionitis on developmental outcome in very low birth weight infants. Obstet Gynecol. 1999;94(2):267–73. https://pubmed.ncbi.nlm.nih.gov/10432141/
Hauth JC, Gilstrap LC, Hankins GDV, Connor KD. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol. 1985;66(1):59–62.
pubmed: 4011072
Bommarito KM, Gross GA, Willers DM, Fraser VJ, Olsen MA. The Effect of Clinical Chorioamnionitis on Cesarean Delivery in the United States. Health Serv Res. 2016;51(5):1879–95.
doi: 10.1111/1475-6773.12447
pubmed: 26841089
pmcid: 5034204
Botet F, Figueras J, Carbonell-Estrany X, Arca G. Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case-control study. J Perinat Med. 2010;38(3):269–73.
doi: 10.1515/jpm.2010.029
pubmed: 20121532