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Chorioamnionitis and Infectious Complications after Vaginal Delivery
Anna E DeNoble1, R Phillips Heine2, Sarah K Dotters-Katz1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
American Journal of Perinatology
|June 26, 2019
Summary
Postpartum infection occurred in 4.3% of women after VBAC with chorioamnionitis. Preterm birth and high BMI increased risk, while postpartum antibiotics reduced infection rates.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Maternal-Fetal Medicine
Background:
- Chorioamnionitis is a known risk factor for postpartum infections.
- Vaginal birth after cesarean (VBAC) is an increasingly common delivery method.
- Understanding infectious complication risks in this specific population is crucial for patient care.
Purpose of the Study:
- To determine the incidence of postpartum infectious complications following VBAC in women with chorioamnionitis.
- To identify significant risk factors associated with these complications.
- To evaluate the protective effect of postpartum antibiotics.
Main Methods:
- Secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Cesarean Registry.
- Defined primary outcome as a composite of postpartum infections.
- Utilized logistic regression for multivariate analysis of predictors.
Main Results:
- A total of 559 women with chorioamnionitis and successful VBAC were analyzed.
- The incidence of postpartum infectious complications was 4.3%, primarily endometritis.
- Preterm delivery (<32 weeks) and prepregnancy BMI (≥40) were significant risk factors.
- Postpartum antibiotic administration showed a protective effect (OR: 0.28).
Conclusions:
- Approximately 5% of women with chorioamnionitis undergoing VBAC experienced postpartum infection.
- Early preterm delivery and obesity are key risk factors.
- Postpartum antibiotics significantly decrease the likelihood of infection.
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