Risk Factors for Histologic Chorioamnionitis Among Women with Prenatal Fever During Preterm Delivery: A Retrospective...

Histologic chorioamnionitis (HCA) complicates preterm birth and adversely affects neonatal and maternal outcomes; however, early recognition remains challenging. Here, we aimed to identify risk factors for HCA and assess its impact on pregnancy outcomes in preterm deliveries with prenatal fever.

Retrospective cohort analysis.

Tertiary obstetrics and Gynecology Hospital in Shanghai, China.

A total of 220 women who delivered preterm (gestational age <37 weeks) with prenatal fever between January 2018 and December 2020 were ultimately included in the study. This included an HCA group (101 cases) and control group (119 cases).

HCA diagnosis by placental pathology; neonatal outcomes.

The incidence of congenital infection (27.66 vs 15.38%, P=0.029) and neonatal sepsis (8.89 vs 0.90%, P=0.017) was significantly greater in the HCA group than in the control group. Fever interval and PROM between 24 to 48 h (aOR=3.603, 95% CI 1.027~12.644) and >48 h (aOR=6.201, 95% CI 1.729~22.238) were associated with HCA. A maternal WBC count ≥11×10⁹/L demonstrated a sensitivity of 80%, a specificity of 46%, a positive predictive value of 56.3%, and a negative predictive value of 73.3% for HCA prediction. A maternal white blood cell count ≥11×10⁹/L demonstrated optimal discriminatory power for HCA (AUC=0.667, 95% CI 0.569~0.738).

HCA significantly increases the risks of neonatal sepsis and congenital infection in preterm infants. A prolonged PPROM-fever interval (> 24 h) and a maternal WBC ≥11×10⁹/L are key predictive factors for the need for active obstetric intervention. This study provides evidence-based cutoff values for clinical decision-making in preterm pregnancies with fever, potentially improving maternal and neonatal outcomes through timely intervention.