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Prematurity

Poster Session 2

(636) Association between histological and clinical chorioamnionitis in patients with PPROM

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Chorioamnionitis is a morbid complication and indication for early delivery in patients with preterm prelabor rupture of membranes (PPROM). Prior studies have shown wide variation and discordance in rates of histological versus clinical chorioamnionitis, and the clinical outcomes associated with histological chorioamnionitis (HCA) are unclear.  We investigated outcomes in patients with HCA after PPROM.

Study Design: This single-center retrospective cohort study included singleton gestations with PPROM between 24+0 and 33+6 weeks with at least 24 hours of latency after PPROM diagnosis from 2019-2021. We included all patients who had placental pathology evaluations performed. The primary outcome was clinical chorioamnionitis. Secondary outcomes were spontaneous labor and non-reassuring fetal status (NRFS).  Outcomes were compared between patients with and without HCA, defined by chorioamnionitis, chorionitis, or funisitis of the amniotic membranes, chorionic plate, and/or umbilical cord as reported on placental pathology. Descriptive and bivariate analyses were used to compare outcomes.

Results: Of the 125 patients meeting inclusion criteria, 121 (96.8%) had placental pathology performed and 64 (52.9%) had HCA. Patients with HCA were more likely to be diagnosed with clinical chorioamnionitis (29.7% vs. 12.3%, p=0.02) and spontaneous labor (54.7% vs. 24.6%, p=0.01) compared to patients without HCA. There was no difference in rates of delivery for NRFS between patients with and without HCA. Among patients delivered for clinical chorioamnionitis, 33.3% did not have HCA. Composite neonatal infectious morbidity did not differ with HCA (4.7% vs. 1.8%, p=0.37).

Conclusion:

More than half of patients with PPROM have HCA. Although HCA was associated with a higher incidence of clinical chorioamnionitis, it appears to be a common pathologic diagnosis with < 30% that have clinical chorioamnionitis. The utility of routine placental evaluation after PPROM should be studied further.