Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione).
Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione).
Am J Obstet Gynecol MFM. 2022 Jan;4(1):100524. doi: 10.1016/j.ajogmf.2021.100524. Epub 2021 Nov 9.
Clinical chorioamnionitis is associated with significant maternal and neonatal morbidity, yet there is no clear evidence on the association between cervical examinations and infection.
We sought to assess the association between the number of cervical examinations performed during term labor management and the risk of clinical chorioamnionitis.
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.
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.
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.
临床绒毛膜羊膜炎与产妇和新生儿发病率显著相关，但目前尚不清楚宫颈检查与感染之间的关系。
我们旨在评估足月分娩期间进行的宫颈检查次数与临床绒毛膜羊膜炎风险之间的关系。
这是一项回顾性队列研究，纳入了 2014 年至 2018 年在我们的三级医疗中心分娩的足月（≥37 孕周）、单胎妊娠的孕妇。临床绒毛膜羊膜炎的主要结局定义为产妇产时发热（单次口腔温度＞39°C 或 38°C-38.9°C 持续 30 分钟）和以下 1 项或多项：产妇白细胞增多、宫颈脓性分泌物或胎儿心动过速。主要暴露因素为病历中记录的数字宫颈检查次数。采用对数二项回归模型来模拟宫颈检查对临床绒毛膜羊膜炎风险的影响，同时调整潜在混杂因素。
共有 20029 名符合纳入标准的个体，其中 1028 名（5%）患者发生了临床绒毛膜羊膜炎。在调整了潜在混杂因素后，宫颈检查次数与感染风险增加相关。与检查 1-3 次的个体相比，检查≥8 次的个体发生临床绒毛膜羊膜炎的风险增加 1.7 倍。破膜时间延长、初产妇、黑人种族、医疗补助保险、较高的胎龄和较高的体重指数与临床绒毛膜羊膜炎的风险增加相关，而吸烟和 B 型链球菌定植与风险降低相关。
我们的研究发现，分娩期间进行的宫颈检查次数是发生临床绒毛膜羊膜炎的独立危险因素。在足月分娩管理中应避免不必要的宫颈检查。
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