Elsevier

Obstetrics & Gynecology

Volume 94, Issue 2, August 1999, Pages 274-278
Obstetrics & Gynecology

Original Articles
Chorioamnionitis and the prognosis for term infants

https://doi.org/10.1016/S0029-7844(99)00256-2Get rights and content

Abstract

Objective: To assess the effects of clinical chorioamnionitis and labor complications on short-term neonatal morbidity, including seizures.

Methods: This was a retrospective cohort study of all live-born term infants who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared between women with and without clinical diagnoses of chorioamnionitis. Chorioamnionitis was based on maternal fever of 38C or greater with supporting clinical evidence including fetal tachycardia, uterine tenderness, and malodorous infant.

Results: A total of 101,170 term infants were analyzed, 5144 (5%) of whom were born to women with chorioamnionitis. Apgar scores of 3 or less at 5 minutes, umbilical artery pH of 7.0 or less, delivery-room intubation, sepsis, pneumonia, seizures in the first 24 hours, and meconium aspiration syndrome were all increased in infants exposed to chorioamnionitis. After adjustment for confounding factors, including route of delivery and length of labor, chorioamnionitis remained significantly associated with intubation in the delivery room (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6), pneumonia (OR 2.2; 95% CI 1.7, 2.8), and sepsis (OR 2.9; 95% CI 2.1, 4.1). Short-term neurologic morbidity, manifest as seizures, was not related to maternal infection during labor, but was significantly related to other labor complications.

Conclusion: The main short-term neonatal consequence of chorioamnionitis is infection. Short-term neurologic morbidity in infants is related to labor complications and not chorioamnionitis per se.

Section snippets

Materials and methods

Between January 1, 1988 and December 31, 1997, all live-born infants who weighed at least 2500 g at Parkland Memorial Hospital, Dallas, Texas, were entered in a computerized database. Delivery events were recorded by attending nurses, and data sheets were checked for accuracy by research nurses. Infant outcomes were abstracted from the newborn discharge records by research nurses, and the results were linked electronically to the maternal outcomes. This study was limited to women with singleton

Results

A total of 101,170 singleton pregnancies with infants who weighed at least 2500 g met the inclusion criteria for analysis. Chorioamnionitis was diagnosed in 5144 (5%) of theses pregnancies. Table 1 summarizes selected maternal demographic and pregnancy characteristics in women with and without chorioamnionitis. Chorioamnionitis was significantly increased in women who were younger, nulliparous, or Hispanic. Similarly, chorioamnionitis was significantly associated with intrapartum hypertension

Discussion

The results of this analysis of more than 100,000 term pregnancies suggest that chorioamnionitis in mothers during labor is associated with adverse infant outcomes. Resuscitation at birth, indicated by intubation in the delivery room, was required in almost 2% of chorioamnionitis infants. Nearly every measure of compromised infant condition at birth was increased in association with maternal infection during labor. The infants also experienced morbidity after their arrival in the nursery, with

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