845: Impact of new “Triple I” classification on clinical chorioamnionitis incidence and neonatal sepsis


      To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor and diagnosis of neonatal sepsis

      Study Design

      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)