Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
BJOG. 2019 May;126(6):719-727. doi: 10.1111/1471-0528.15565. Epub 2019 Jan 5.
To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery.
A retrospective cohort study.
Data from the Consortium on Safe Labor Study in the USA (2002-2008).
Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section).
The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery.
The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death.
Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97-2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes.
Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis.
Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery.
通过分娩方式研究绒毛膜羊膜炎及其持续时间与不良母婴结局的关系。
回顾性队列研究。
美国安全分娩联合会研究（2002-2008 年）。
妊娠 23 周及以上的单胎分娩（221274 例评估分娩，62331 例剖宫产）。
采用广义估计方程的逻辑回归分析绒毛膜羊膜炎与不良母婴结局的关系，同时从产时使用抗生素的情况来估计绒毛膜羊膜炎的持续时间，调整年龄、产次、种族、孕前糖尿病、慢性高血压、分娩时孕周、研究地点和分娩年份。分析按阴道分娩与剖宫产分层。
复合不良母婴结局包括：产后输血、子宫内膜炎、伤口/会阴感染/分离、静脉血栓栓塞、子宫切除术、入住重症监护病房和/或死亡。
绒毛膜羊膜炎与剖宫产时复合不良母婴结局的发生风险较高相关（调整后的比值比 2.31；95%可信区间 1.97-2.71）；而且无论女性是否尝试阴道分娩、早产或母体 B 组链球菌定植，这种关联都持续存在。剖宫产术后最常见的不良结局是产后输血（56.0%）和伤口/会阴感染或子宫内膜炎（38.6%）。绒毛膜羊膜炎与阴道分娩后的不良母婴结局无关。绒毛膜羊膜炎的持续时间作为暴露因素并没有改变绒毛膜羊膜炎与不良母婴结局之间的关联。
绒毛膜羊膜炎而不是估计的持续时间与剖宫产时不良母婴结局的发生风险增加相关。这一发现对预防绒毛膜羊膜炎合并剖宫产相关产妇发病率的护理方案具有重要意义。
绒毛膜羊膜炎而不是其持续时间增加了剖宫产时不良母婴结局的风险。
