Incremental risk of clinical chorioamnionitis associated with cervical examination.

Autor: Gomez Slagle HB; Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione). Electronic address: Helen.gomez@christianacare.org., Hoffman MK; Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione)., Fonge YN; Division of Maternal Fetal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (Dr Fonge)., Caplan R; Department of Research at Christiana Care, Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, DE (Dr Caplan)., Sciscione AC; Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione); Department of Obstetric and Gynecology at Christiana Care Health System, Newark, DE (Dr Sciscione).
Jazyk: angličtina
Zdroj: American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2022 Jan; Vol. 4 (1), pp. 100524. Date of Electronic Publication: 2021 Nov 09.
DOI: 10.1016/j.ajogmf.2021.100524
Abstrakt: Background: Clinical chorioamnionitis is associated with significant maternal and neonatal morbidity, yet there is no clear evidence on the association between cervical examinations and infection.
Objective: We sought to assess the association between the number of cervical examinations performed during term labor management and the risk of clinical chorioamnionitis.
Study Design: This is a retrospective cohort study of term (≥37 weeks of gestation), singleton pregnancies who labored at our tertiary care center from 2014 to 2018. The primary outcome of clinical chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38°C-38.9°C for 30 minutes) and 1 or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the number of digital cervical exams documented in the medical record. Log-binomial regression was used to model the effect of cervical examinations on the risk of clinical chorioamnionitis while adjusting for potential confounders.
Results: A total of 20,029 individuals met the inclusion criteria and 1028 (5%) patients experienced clinical chorioamnionitis. The number of cervical exams was associated with increased risk of developing infection after adjusting for potential confounders. Individuals with ≥8 cervical exams had 1.7 times the risk of developing clinical chorioamnionitis compared with those with 1 to 3 exams. Prolonged rupture time, nulliparity, Black race, Medicaid insurance, higher gestational age, and higher body mass index were associated with increased risk of clinical chorioamnionitis, whereas smoking and group B Streptococcus colonization were associated with a lower risk.
Conclusion: Our study found that the number of cervical exams performed during labor is an independent risk factor for developing clinical chorioamnionitis. Unnecessary cervical exams should be avoided during labor management at term.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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