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To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor and diagnosis of neonatal sepsis
Retrospective cohort of women who delivered (≥35 weeks gestation) at Thomas Jefferson University between 10/2013 and 3/2017 and were diagnosed with clinical chorioamnionitis during labor. This cohort was reclassified using the “Triple I” criteria. Maternal fever was defined as temperature ≥39.0° or two episodes of temperature between 38.0°-38.9°. Suspected triple I: maternal fever plus one of the following: fetal tachycardia >160 for >10 minutes, white blood cells > 15000, or foul smelling discharge. Confirmed triple I by histology or amniotic fluid culture in mothers with suspected triple I. Clinical illness in neonates: signs suggestive of sepsis. Neonatal sepsis: positive blood or CSF culture. Primary outcome: Incidence of suspected and confirmed Triple I. Secondary outcomes: Incidence of clinical illness and positive culture in neonates.
460 women were diagnosed with clinical chorioamnionitis during labor. 74 (16%) had isolated maternal fever, 187 (40.6%) met criteria for suspected Triple I and among them 151 (33%) were confirmed Triple I by histology. Demographics and delivery outcome among these three groups were not significantly different (Table 1). Clinical signs suggestive of neonatal sepsis were identified in 139 (30.2%) infants born to mothers with clinical chorioamnionitis, but only 21 (4.6%) in the isolated maternal fever and 55 (11.9%) in the suspected Triple I groups. Only one infant (0.2%) had culture positive sepsis and was born to a mother with suspected and confirmed Triple I. (Table 2)