Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

Diagnosis and Management of Intraamniotic Infection

Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention,cesarean birth,postpartum uterine atony with hemorrhage,endometritis,peritonitis,sepsis,adult respiratory distress syndrome and,rarely,death.Chorioamnionitis can result from an ascending infection,iatrogenic causes or transplacental passage from maternal blood-borne infections.The clinical findings of chorioamnionitis include maternal fever(≥38°C),maternal(>100 beats per minute)and/or fetal tachycardia(>160 beats per minute),maternal leukocytosis on complete blood count(>15000 cells/mm 3),and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid.The management of chorioamnionitis mainly includes antibiotic therapy and delivery.Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach.The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible,with appropriate neonatal resuscitation available.