INTRODUCTION
Intraamniotic infection, or chorioamnionitis, is an infection caused by
microbial invasion of the amniotic cavity, triggering maternal
inflammatory response and acute inflammation of any combination of the
placenta, amniotic fluid, fetus, fetal membranes or decidua (1, 2).
Established risk factors for chorioamnionitis include nulliparity,
urogenital infections during pregnancy, prolonged membrane rupture, and
multiple cervical examinations during labor (1-4). Chorioamnionitis
should be suspected in the presence of maternal intrapartum fever in
combination with clinical signs of infection and/or fetal distress, such
as maternal leukocytosis, fetal tachycardia (5), purulent cervical
drainage (2), uterine tenderness, maternal tachycardia, maternal
malaise, elevated C-reactive protein (CRP) and foul-smelling water or
discharge (1, 3, 6, 7).
Between 1 and 5% of term deliveries are estimated to be complicated by
chorioamnionitis, which is associated with a significantly increased
risk of maternal, fetal and neonatal morbidity and mortality (2, 3).
Neonates exposed to chorioamnionitis are at increased risk of severe
infections in the neonatal period (3, 8-10), and are likewise at an
increased risk of impaired short- and long-term neurological outcomes,
hypothesized to be a consequence of the fetal hyperinflammatory response
to the infection (11, 12). Undoubtedly, early identification and timely
treatment of chorioamnionitis in combination with close collaboration
between obstetric and pediatric care is essential to improve neonatal
outcomes (13), but precise clinical predictors of neonatal complications
are lacking. A majority of studies have focused on chorioamnionitis
complicating preterm deliveries, whereas only a few studies have
investigated the potential impact of clinical and laboratory
characteristics of term deliveries complicated by chorioamnionitis. Risk
prediction models based on gestational age (14), duration of membrane
rupture, highest maternal intrapartum temperature and timing of
intrapartum antibiotic administration have been proposed (2, 3), but
except for maternal intrapartum temperature, no study have investigated
the association between clinical and laboratory characteristics of
chorioamnionitis and risk of adverse neonatal outcomes at term
gestation.
The aim of our study was therefore to describe clinical and laboratory
characteristics of term deliveries complicated by chorioamnionitis.
Moreover, we aimed at assessing the impact of these clinical and
laboratory characteristics on the risk of adverse neonatal outcomes in
term deliveries complicated by chorioamnionitis.