Incremental risk of clinical chorioamnionitis associated with cervical examination

Helen B Gomez Slagle; Matthew K Hoffman; Yaneve N Fonge; Richard Caplan; Anthony C Sciscione

doi:10.1016/j.ajogmf.2021.100524

Incremental risk of clinical chorioamnionitis associated with cervical examination

Am J Obstet Gynecol MFM. 2022 Jan;4(1):100524. doi: 10.1016/j.ajogmf.2021.100524. Epub 2021 Nov 9.

Authors

Helen B Gomez Slagle¹, Matthew K Hoffman², Yaneve N Fonge³, Richard Caplan⁴, Anthony C Sciscione⁵

Affiliations

¹ Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione). Electronic address: Helen.gomez@christianacare.org.
² Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione).
³ Division of Maternal Fetal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (Dr Fonge).
⁴ Department of Research at Christiana Care, Institute for Research on Equity and Community Health, Christiana Care Health System, Newark, DE (Dr Caplan).
⁵ Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Gomez Slagle, Hoffman, and Sciscione); Department of Obstetric and Gynecology at Christiana Care Health System, Newark, DE (Dr Sciscione).

PMID: 34768023
DOI: 10.1016/j.ajogmf.2021.100524

Abstract

Background: Clinical chorioamnionitis is associated with significant maternal and neonatal morbidity, yet there is no clear evidence on the association between cervical examinations and infection.

Objective: We sought to assess the association between the number of cervical examinations performed during term labor management and the risk of clinical chorioamnionitis.

Study design: This is a retrospective cohort study of term (≥37 weeks of gestation), singleton pregnancies who labored at our tertiary care center from 2014 to 2018. The primary outcome of clinical chorioamnionitis was defined as maternal intrapartum fever (single oral temperature of >39°C or 38°C-38.9°C for 30 minutes) and 1 or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The primary exposure was the number of digital cervical exams documented in the medical record. Log-binomial regression was used to model the effect of cervical examinations on the risk of clinical chorioamnionitis while adjusting for potential confounders.

Results: A total of 20,029 individuals met the inclusion criteria and 1028 (5%) patients experienced clinical chorioamnionitis. The number of cervical exams was associated with increased risk of developing infection after adjusting for potential confounders. Individuals with ≥8 cervical exams had 1.7 times the risk of developing clinical chorioamnionitis compared with those with 1 to 3 exams. Prolonged rupture time, nulliparity, Black race, Medicaid insurance, higher gestational age, and higher body mass index were associated with increased risk of clinical chorioamnionitis, whereas smoking and group B Streptococcus colonization were associated with a lower risk.

Conclusion: Our study found that the number of cervical exams performed during labor is an independent risk factor for developing clinical chorioamnionitis. Unnecessary cervical exams should be avoided during labor management at term.

Keywords: cervical exam; clinical chorioamnionitis; infection; intraamniotic infection; labor management; term pregnancy.

MeSH terms

Chorioamnionitis* / epidemiology
Female
Humans
Infant, Newborn
Labor, Obstetric*
Parturition
Pregnancy
Retrospective Studies
Streptococcus agalactiae
United States