Clinical Characteristics and Predictors of Impaired Neonatal Outcomes in
Chorioamnionitis at Term Gestation: A cross-sectional cohort study
Abstract
Objective: To describe clinical and laboratory characteristics
of term deliveries complicated by chorioamnionitis, and to assess their
association with adverse neonatal outcomes. Design:
Cross-sectional cohort study Setting: The study is based on
data from the Swedish Pregnancy Register, enriched with clinical data
extracted from medical charts. Population and Sample: A random
sample of 500 term singleton deliveries in Stockholm County with
registered diagnosis of chorioamnionitis in the Swedish Pregnancy
Register between 2014 and 2020. Methods: Logistic regression
was used to estimate odds ratios (OR) as a measurement of the
association between clinical and laboratory characteristics and neonatal
complications Main Outcome Measures: Neonatal infection and
asphyxia-related complications. Results: Maternal fever,
maternal and fetal tachycardia, and elevated inflammatory laboratory
markers were frequent signs of chorioamnionitis. The prevalence of
neonatal infection and asphyxia-related complications was 10 and 22%,
respectively. First leukocyte count in the second tertile (OR 2.14
[95% CI 1.02-4.49]), maximum CRP level in the third tertile (OR
4.01 [95% Cl 1.66-9.68]), and positive cervical culture (OR 2.22
[95% Cl 1.10-4.48]) were associated with an increased risk of
neonatal infection. Maximum level of CRP in the third tertile (OR 1.93
[95% Cl 1.09-3.41]), and fetal tachycardia (OR 1.63 [95% Cl
1.01-2.65]) were associated with increased risk of asphyxia-related
complications. Conclusions: In addition to maternal intrapartum
fever, maternal and fetal tachycardia, and elevated inflammatory
laboratory markers were common signs of chorioamnionitis. Elevated
inflammatory laboratory markers were associated with both neonatal
infection and asphyxia-related complications, and fetal tachycardia was
associated asphyxia-related complications.