Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Infectious Diseases

Poster Session 3

(905) Mode of delivery in chorioamnionitis: impact on neonatal and parturient outcomes

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Michelle Morais, MD (she/her/hers)

Associate Professor
McMaster University
Hamilton, ON, Canada

Coauthor(s)

IL

Isabella Liang, MD

McMaster University
Hamilton, ON, Canada
JT

Jennifer Twiss, MD

McMaster University
Hamilton, ON, Canada

Objective: The impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares risk of early onset neonatal sepsis between vaginal delivery and cesarean section. Subgroup analysis was done by indication for cesarean section.

Study Design: Singleton pregnancies at greater than 24+0 weeks gestation with live birth and clinical chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Risk of early onset neonatal sepsis and a composite outcome of parturient infectious morbidity were compared using propensity score weighting.

Results: 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibb’s criteria. Risk of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5-13.1], p=0.0007). Secondary neonatal outcomes were similar between groups. When compared by indication, risk of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. In parturients, the risk of infectious morbidity was greater with cesarean section (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1-18.9], p < 0.0001). No other difference in parturient secondary outcomes was identified except a longer hospital stay after cesarean section (2.3days ±0.93 versus 1.6days ±0.92, p < 0.0001).

Conclusion: The risk of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Neonates affected by or vulnerable to sepsis likely have a greater need for cesarean section. The evidence supports cesarean section only for routine obstetrical indications in chorioamnionitis.