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BMC Pediatrics
Published in: BMC Pediatrics 1/2022

01-12-2022 | Paracetamol | Research

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

Authors: Anvar Paraparambil Vellamgot, Khalil Salameh, Lina Hussain M. Habboub, Rajesh Pattuvalappil, Naser Abulgasim Elkabir, Yousra Shehada Siam, Hakam Khatib

Published in: BMC Pediatrics | Issue 1/2022

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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, between1stJanuary2016 to 31stDecember 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.
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Literature
1.
Chorioamnionitis Newton E, Infection Intraamniotic. Clin Obstet Gynecol. 1993;36(4):795–808.CrossRef
2.
3.
Gibbs R, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991;164(5):1317–26.PubMedCrossRef
4.
Escobar G, Li D, Armstrong M, Gardner M, Folck B, Verdi J, et al. Neonatal Sepsis Workups in Infants ≥2000 Grams at Birth: A Population-Based Study. Pediatrics. 2000;106(2):256–63.PubMedCrossRef
5.
Alexander J, McIntire D, Leveno K. Chorioamnionitis and the Prognosis for Term Infants. Obstet Gynecol. 1999;94(2):274–8.
6.
Yoder P, Gibbs R, Blanco J, Castaneda Y, St. Clair P. A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term. Am J Obstet Gynecol  1983;145(6):695–701.PubMedCrossRef
7.
Lau J, Magee F, Qiu Z, Houbé J, Von Dadelszen P, Lee S. Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only. Am J Obstet Gynecol. 2005;193(3):708–13.PubMedCrossRef
8.
Aziz N, Cheng Y, Caughey A. Neonatal outcomes in the setting of preterm premature rupture of membranes complicated by chorioamnionitis. J Matern-Fetal Neonatal Med. 2009;22(9):780–4.CrossRef
9.
Ramsey P, Lieman J, Brumfield C, Carlo W. Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet Gynecol. 2005;192(4):1162–6.PubMedCrossRef
10.
Greco P, Nencini G, Piva I, Scioscia M, Volta C, Spadaro S, et al. Pathophysiology of hypoxic–ischemic encephalopathy: a review of the past and a view on the future. Acta Neurol Belg. 2020;120(2):277–88.PubMedCrossRef
11.
Kim C, Romero R, Chaemsaithong P, Chaiyasit N, Yoon B, Kim Y. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015;213(4):S29–52.PubMedPubMedCentralCrossRef
12.
Maisonneuve E, Lorthe E, Torchin H, Delorme P, Devisme L, L’Hélias L, et al. Association of Chorioamnionitis with Cerebral Palsy at Two Years after Spontaneous Very Preterm Birth: The EPIPAGE-2 Cohort Study. J Pediatr. 2020;222:71–78.e6.PubMedCrossRef
13.
Johnson C, Burd I, Raghunathan R, Northington F, Graham E. Perinatal inflammation/infection and its association with correction of metabolic acidosis in hypoxic-ischemic encephalopathy. J Perinatol. 2016;36(6):448–52.PubMedPubMedCentralCrossRef
14.
Higgins R, Saade G, Polin R, Grobman W, Buhimschi I, Watterberg K, et al. Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis. Obstet Gynecol. 2016;127(3):426–36.CrossRef
15.
Burgess A, Katz J, Moretti M, Lakhi N. Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae. Gynecol Obstet Invest. 2017;82(5):508–16.PubMedCrossRef
16.
Wang C, Schroeder I, Cazales A, Kim R, Albert A, Elwood C, et al. Management of fever in labor after institution of a standardized order set at a maternity quaternary care center. American J Obstet Gynecol. 2019;221(6):687.CrossRef
17.
18.
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 Fetal Neonatal Med. 2018;31(11):1418–25.PubMedCrossRef
19.
Lieberman E, Cohen A, Lang J, Frigoletto F, Goetzl L. Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery. Am J Public Health. 1999;89(4):506–10.PubMedPubMedCentralCrossRef
20.
Dior UP, Kogan L, Eventov-Friedman S, Gil M, Bahar R, Ergaz Z, et al. Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes. Neonatology. 2016;109(1):62–8.PubMedCrossRef
21.
Lange EMS, Segal S, Pancaro C, Wong CA, Grobman WA, Russell GB, et al. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study. Anesthesiology. 2017;127(6):942–52.PubMedCrossRef
22.
Perlman JM. Hyperthermia in the delivery: potential impact on neonatal mortality and morbidity. Clin Perinatol. 2006;33(1):55–63 vi.PubMedCrossRef
23.
Blume HK, Li CI, Loch CM, Koepsell TD. Intrapartum fever and chorioamnionitis as risks for encephalopathy in term newborns: a case-control study. Dev Med Child Neurol. 2008;50(1):19–24.PubMedCrossRef
24.
Törnell S, Ekéus C, Hultin M, Håkansson S, Thunberg J, Högberg U. Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study. Acta Anaesthesiol Scand. 2015;59(4):486–95.PubMedCrossRef
25.
Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998;317(7172):1554–8.PubMedPubMedCentralCrossRef
26.
Impey LW, Greenwood CE, Black RS, Yeh PS, Sheil O, Doyle P. The relationship between intrapartum maternal fever and neonatal acidosis as risk factors for neonatal encephalopathy. Am J Obstet Gynecol. 2008;198(1):49.e1–6.CrossRef
27.
Kasdorf E, Perlman JM. Hyperthermia, inflammation, and perinatal brain injury. Pediatr Neurol. 2013;49(1):8–14.PubMedCrossRef
28.
Li C, Miao JK, Xu Y, Hua YY, Ma Q, Zhou LL, et al. Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis. Eur J Neurol. 2017;24(8):1006–15.PubMedCrossRef
29.
Greenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics. 2012;129(2):e447–54.PubMedPubMedCentralCrossRef
30.
Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV. Association of maternal fever during labor with neonatal and infant morbidity and mortality. Obstet Gynecol. 2001;98(1):20–7.PubMed
31.
Glass HC, Pham TN, Danielsen B, Towner D, Glidden D, Wu YW. Antenatal and intrapartum risk factors for seizures in term newborns: a population-based study, California 1998–2002. J Pediatr. 2009;154(1):24–28.e1.PubMedCrossRef
32.
33.
Spain JE, Tuuli MG, Macones GA, Roehl KA, Odibo AO, Cahill AG. Risk factors for serious morbidity in term nonanomalous neonates. Am J Obstet Gynecol. 2015;212(6):799.e1–7.CrossRef
34.
Polin RA, Watterberg K, Benitz W, Eichenwald E. The conundrum of early-onset sepsis. Pediatrics. 2014;133(6):1122–3.PubMedCrossRef
35.
Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, et al. A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis. JAMA Pediatr. 2017;171(4):365–71.PubMedCrossRef
36.
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.PubMedPubMedCentralCrossRef
37.
Soper DE, Mayhall CG, Froggatt JW. Characterization and control of intraamniotic infection in an urban teaching hospital. Am J Obstet Gynecol. 1996;175(2):304–9 discussion 309-10.PubMedCrossRef
38.
Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997;177(5):1024–9.PubMedCrossRef
39.
Tran SH, Caughey AB, Musci TJ. Meconium-stained amniotic fluid is associated with puerperal infections. Am J Obstet Gynecol. 2003;189(3):746–50.PubMedCrossRef
40.
Cheng YW, Delaney SS, Hopkins LM, Caughey AB. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor. Am J Obstet Gynecol. 2009;201(5):477.e1–7.CrossRef
41.
Cohen-Cline HN, Kahn TR, Hutter CM. A population-based study of the risk of repeat clinical chorioamnionitis in Washington State, 1989–2008. Am J Obstet Gynecol. 2012;207(6):473.e1–7.CrossRef
42.
Afjeh S, Sabzehei MK, Mansor Ghanaie R, Karimizadeh M, Shamshiri AR, Esmaili F. Chorioamnionitis and Neonates; Which Strategy? Arch Iran Med. 2020;23(7):480–7.PubMedCrossRef
43.
ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109(4):1007–19.CrossRef
44.
Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol. 1989;161(3):562–6 discussion 566–8.PubMedCrossRef
45.
Rickert VI, Wiemann CM, Hankins GD, McKee JM, Berenson AB. Prevalence and risk factors of chorioamnionitis among adolescents. Obstet Gynecol. 1998;92(2):254–7.PubMedCrossRef
46.
Romero R, Hanaoka S, Mazor M, Athanassiadis AP, Callahan R, Hsu YC, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol. 1991;164(3):859–62.PubMedCrossRef
47.
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.PubMedCrossRef
48.
Cahill AG, Duffy CR, Odibo AO, Roehl KA, Zhao Q, Macones GA. Number of cervical examinations and risk of intrapartum maternal fever. Obstet Gynecol. 2012;119(6):1096–101.PubMedCrossRef
49.
Lieberman E, Lang J, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A. Intrapartum maternal fever and neonatal outcome. Pediatrics. 2000;105(1 Pt 1):8–13.PubMedCrossRef
50.
Sahni M, Franco-Fuenmayor ME, Shattuck K. Management of Late Preterm and Term Neonates exposed to maternal Chorioamnionitis. BMC Pediatr. 2019;19(1):282.PubMedPubMedCentralCrossRef
51.
Duff P. Maternal and perinatal infection—bacterial. In: Gabbe SG, Niebyl JR, Simpson JL, editors. Obstetrics: Normal and Problem Pregnancies. 6th ed. New York: Churchill Livingstone; 2012. p. 1140–55.CrossRef
52.
Holzman C, Lin X, Senagore P, Chung H. Histologic chorioamnionitis and preterm delivery. Am J Epidemiol. 2007;166(7):786–94.PubMedCrossRef
53.
Smulian JC, Shen-Schwarz S, Vintzileos AM, Lake MF, Ananth CV. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol. 1999;94(6):1000–5.PubMed
54.
Romero R, Miranda J, Kusanovic JP, Chaiworapongsa T, Chaemsaithong P, Martinez A, 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.PubMedPubMedCentralCrossRef
55.
Shalak LF, Perlman JM, Jackson GL, Laptook AR. Depression at birth in term infants exposed to maternal chorioamnionitis: does neonatal fever play a role. J Perinatol. 2005;25(7):447–52.PubMedCrossRef
56.
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.PubMedCrossRef
57.
Lavesson T, Åkerman F, Källén K, Olofsson P. Effects on fetal and maternal temperatures of paracetamol administration during labour: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2013;168(2):138–44.PubMedCrossRef
58.
Goetzl L, Rivers J, Evans T, Citron DR, Richardson BE, Lieberman E, et al. Prophylactic acetaminophen does not prevent epidural fever in nulliparous women: a double-blind placebo-controlled trial. J Perinatol. 2004;24(8):471–5.PubMedCrossRef
Metadata
Title
Suspected clinical chorioamnionitis with peak intrapartum temperature <380C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome
Authors
Anvar Paraparambil Vellamgot
Khalil Salameh
Lina Hussain M. Habboub
Rajesh Pattuvalappil
Naser Abulgasim Elkabir
Yousra Shehada Siam
Hakam Khatib
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Paracetamol
Published in
BMC Pediatrics / Issue 1/2022
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-022-03239-9

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