(1174) Impact of Chorioamnionitis on Maternal and Neonatal Outcomes Categorized by Presence or Absence of Fever

To examine the impact of a chorioamnionitis diagnosis on maternal and neonatal outcomes categorized by the presence or absence of documented fever.

Study Design:

We conducted a secondary analysis using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. We excluded individuals who delivered before 20 weeks' gestation and those with missing chorioamnionitis data, then categorized participants based on the diagnosis of chorioamnionitis with versus without fever. Data was obtained prospectively by trained research coordinators. Our primary outcome was the neonatal composite outcome including suspected or confirmed neonatal sepsis, necrotizing enterocolitis, respiratory distress/transient tachypnea of the newborn (RDS/TTN), seizure, hypoglycemia, and hyperbilirubinemia. We also examined maternal outcomes (cesarean delivery, endometritis, and postpartum hemorrhage). We calculated adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) using modified Poisson regression.

Results:

Of 9,432 individuals, 574 (6.1%) had chorioamnionitis with fever and 46 (0.5%) had chorioamnionitis without fever. Proportions and relative risks of outcomes are present in Tables 1 and 2. Compared to individuals with no chorioamnionitis, chorioamnionitis without fever was associated with higher risks of neonatal composite outcomes, neonatal sepsis, RDS/TTN cesarean delivery and postpartum hemorrhage. Compared to individuals with no chorioamnionitis, chorioamnionitis with fever was associated with higher risks of neonatal composite outcomes, neonatal sepsis, RDS/TTN, hypoglycemia, cesarean delivery, endometritis; and lower risk of hyperbilirubinemia.

Conclusion: Chorioamnionitis is associated with adverse maternal and neonatal outcomes regardless of fever, supporting ACOG's recommendations for diagnosing intraamniotic infections without maternal fever.