The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat Gan, Israel.
Arch Gynecol Obstet. 2020 Dec;302(6):1345-1352. doi: 10.1007/s00404-020-05717-w. Epub 2020 Aug 4.
Intraamniotic infection, categorized into isolated maternal fever, suspected intraamniotic infection (SII), and confirmed intraamniotic infection, is associated with neonatal morbidity. However, there is paucity of data regarding the association between intraamniotic infection duration and neonatal outcomes among term singleton vaginal deliveries. We aimed to study the risk factors for adverse neonatal outcome among vaginal deliveries complicated by SII.
A retrospective observational study conducted at a tertiary medical center. All consecutive singleton term deliveries with SII were included between 2011 and 2019. Maternal and obstetrical characteristics were evaluated to identify risk factors for adverse neonatal outcome. Correlation between SII duration and neonatal adverse outcome was analyzed.
Overall, 882 were analyzed. Most women (85.4%) were primiparous. Median gestation age at delivery was 40 weeks. Median time from SII to delivery was 170 min. Adverse neonatal outcomes occurred in 113 (12.8%) of deliveries. Duration of SII was not associated with adverse neonatal outcome. Analysis for determinants of adverse neonatal outcome revealed that oligohydramnios was more common in pregnancies with adverse neonatal outcome (7/113 (6.2%) vs. 41 (5.4%) OR [95% CI] 2.47 (1.02-5.98), p = 0.03). Duration of second stage of labor was longer in the adverse outcome group (median 179 min vs. 126 min, p = 0.008). Prolonged second stage was more common in the adverse outcome group (60 (53.1%) vs. 273 (35.5%) OR [95% CI] 2.05 (1.38-3.06), p < 0.001). On logistic regression analysis, prolonged second stage was the only modifiable factor independently associated with adverse neonatal outcome [adjusted OR 2.09 (1.37-3.2), p = 0.001]. Other variables tested did not differ between groups. Only phototherapy and base excess ≥ 12 mmol/L were significantly associated with the duration of second stage of labor; for each additional hour of the second stage, the OR for the former increased by 0.34 (p = 0.008), and for the latter by 0.69 (p = 0.007).
Duration of suspected intraamniotic infection was not associated with increased neonatal morbidity among women delivering vaginally at term. Prolonged second stage was a strong independent predictor of an adverse neonatal outcome among fetuses exposed to intraamniotic infection.
宫腔内感染分为单纯母体发热、疑似宫腔内感染（SII）和确诊宫腔内感染，与新生儿发病率有关。然而，关于足月阴道分娩中宫腔内感染持续时间与新生儿结局之间的关系，数据很少。我们旨在研究 SII 合并阴道分娩中不良新生儿结局的危险因素。
这是在一家三级医疗中心进行的回顾性观察性研究。纳入了 2011 年至 2019 年期间所有患有 SII 的连续单胎足月阴道分娩的患者。评估了产妇和产科特征，以确定不良新生儿结局的危险因素。分析 SII 持续时间与新生儿不良结局之间的相关性。
共分析了 882 例。大多数女性（85.4%）为初产妇。中位分娩时孕周为 40 周。中位从 SII 到分娩的时间为 170 分钟。113 例（12.8%）分娩中出现不良新生儿结局。SII 持续时间与新生儿不良结局无关。对不良新生儿结局决定因素的分析表明，羊水过少在出现不良新生儿结局的妊娠中更为常见（7/113（6.2%）与 41（5.4%），比值比[95%CI]2.47（1.02-5.98），p=0.03）。不良结局组的第二产程时间较长（中位数 179 分钟与 126 分钟，p=0.008）。不良结局组中第二产程延长更为常见（60（53.1%）与 273（35.5%），比值比[95%CI]2.05（1.38-3.06），p<0.001）。在逻辑回归分析中，第二产程延长是唯一与不良新生儿结局相关的可改变因素[调整比值比 2.09（1.37-3.2），p=0.001]。其他测试的变量在组间没有差异。只有光疗和碱剩余≥12mmol/L 与第二产程时间显著相关；第二产程每增加 1 小时，前者的比值比增加 0.34（p=0.008），后者增加 0.69（p=0.007）。
足月阴道分娩时，疑似宫腔内感染的持续时间与新生儿发病率的增加无关。第二产程延长是胎儿暴露于宫腔内感染时不良新生儿结局的一个强有力的独立预测因素。
