Association of Clinical Signs of Chorioamnionitis with Histological Chorioamnionitis and Neonatal Outcomes in Women with Premature Rupture of Membranes

Abstract

Background: Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of  chorioamnionitis with its attendant feto-maternal complications.

Aim: The study was aimed to determine the association of clinical signs  of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM.

Materials and Methods: Eligible  participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were  consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb’s criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the  proportion of women with PROM and histological chorioamnionitis that were detected clinically.

Results: Of the 136 participants  analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis  was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm  than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical  signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A  combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator  of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar  score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM.

Conclusion: Clinical signs of  chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.