Limited Course of Antibiotic Treatment for Chorioamnionitis

Black, Lauren Page; Hinson, Lindsay; Duff, Patrick

doi:10.1097/aog.0b013e31824b2e29

Cited by 87 publications

(8 citation statements)

References 12 publications

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“…This study concluded that a single dose of postpartum antibiotics was associated with a low rate of treatment failure (6%), but again did not include a comparison control group who did not receive antibiotics. 9 Our study suggests that women who receive postpartum antibiotics for the indication of chorioamnionitis after vaginal delivery may be less likely to develop postpartum infectious complications than women who receive no antibiotics. In light of the overall low rate of postpartum infectious complications of 4.3%, treating all patients with chorioamnionitis with prophylactic antibiotics after vaginal delivery may not be cost-effective nor would such a protocol promote antibiotic stewardship.…”

Section: Discussionmentioning

confidence: 66%

Chorioamnionitis and Infectious Complications after Vaginal Delivery

2019

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Objective To estimate the incidence of and define risk factors for postpartum infectious complications after vaginal birth after cesarean (VBAC) complicated by chorioamnionitis. Study Design A secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Cesarean Registry was performed. The primary outcome was a composite of postpartum infection: endometritis, sepsis, pelvic abscess, urinary tract infection, necrotizing fasciitis, and septic pelvic thrombophlebitis. Peripartum predictors were compared using parametric and nonparametric tests, as appropriate, and multivariate predictors assessed using logistic regression. Results A total of 559 subjects had chorioamnionitis in labor and a successful VBAC. Twenty-four (4.3%) subjects experienced the primary outcome, mainly due to endometritis (19/24). Significant factors included preterm delivery <32 weeks (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.32–7.06) and body mass index (BMI) ≥40 (OR: 4.63, 95% CI: 1.25–17.14). Receipt of postpartum antibiotics was protective against postpartum infection (OR: 0.28, 95% CI: 0.12–0.65). In multivariate analysis, preterm delivery <32 weeks, BMI ≥40, and receipt of postpartum antibiotics remained associated with postpartum infection. Conclusion Nearly 5% of women with chorioamnionitis had a postpartum infectious complication after vaginal delivery, with higher rates in those delivering at <32 weeks and with prepregnancy BMI ≥40. Receipt of postpartum antibiotics decreased the odds of postpartum infection markedly.

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Section: Discussionmentioning

confidence: 66%

Chorioamnionitis and Infectious Complications after Vaginal Delivery

2019

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“…Even in women undergoing cesarean delivery, one more dose of antimicrobial agents after delivery has the same efficacy as continuing for longer duration. 43–45 The presence of other maternal factors in the postpartum period, such as bacteremia, sepsis and persistent fever may be used to guide duration of antimicrobial therapy.…”

Section: Maternal Managementmentioning

confidence: 99%

Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis

Higgins

Saade

Polin

et al. 2016

Obstetrics &Amp; Gynecology

451

324

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In January 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) invited an expert panel to a workshop to address numerous knowledge gaps, and to provide evidence-based guidelines for the diagnosis and management of pregnant women with what had been commonly called chorioamnionitis and the infants born to these women. The panel noted that the term chorioamnionitis has been used to label a heterogeneous array of conditions characterized by infection and inflammation or both, with a consequent great variation in clinical practice for mothers and their newborns. Therefore, the panel proposed to replace the term chorioamnionitis with a more general, descriptive term, “intrauterine inflammation or infection or both,” abbreviated as “Triple I.” The panel proposed a classification for Triple I and recommended approaches to evaluation and management of pregnant women and their newborns with a diagnosis of Triple I. It is particularly important to recognize that an isolated maternal fever is not synonymous with chorioamnionitis. A research agenda was proposed to further refine the definition and management of this complex group of conditions. This article provides a summary of the workshop presentations and discussions.

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“…Beyond choice of antibiotic regimen, it is important to note that other clinical factors may also have an impact on infection risk, including frequency of antibiotic dosing, prolonged rupture of membranes, and maternal obesity. 15 These results with regard to the optimal antibiotic regimen can inform maternal safety bundles currently underway to prevent peripartum morbidity, 13,41 but will need to be replicated in contemporary prospective cohorts. Original Research…”

Section: Discussionmentioning

confidence: 99%