INTRODUCTION
Intraamniotic infection, or chorioamnionitis, is an infection caused by microbial invasion of the amniotic cavity, triggering maternal inflammatory response and acute inflammation of any combination of the placenta, amniotic fluid, fetus, fetal membranes or decidua (1, 2).
Established risk factors for chorioamnionitis include nulliparity, urogenital infections during pregnancy, prolonged membrane rupture, and multiple cervical examinations during labor (1-4). Chorioamnionitis should be suspected in the presence of maternal intrapartum fever in combination with clinical signs of infection and/or fetal distress, such as maternal leukocytosis, fetal tachycardia (5), purulent cervical drainage (2), uterine tenderness, maternal tachycardia, maternal malaise, elevated C-reactive protein (CRP) and foul-smelling water or discharge (1, 3, 6, 7).
Between 1 and 5% of term deliveries are estimated to be complicated by chorioamnionitis, which is associated with a significantly increased risk of maternal, fetal and neonatal morbidity and mortality (2, 3). Neonates exposed to chorioamnionitis are at increased risk of severe infections in the neonatal period (3, 8-10), and are likewise at an increased risk of impaired short- and long-term neurological outcomes, hypothesized to be a consequence of the fetal hyperinflammatory response to the infection (11, 12). Undoubtedly, early identification and timely treatment of chorioamnionitis in combination with close collaboration between obstetric and pediatric care is essential to improve neonatal outcomes (13), but precise clinical predictors of neonatal complications are lacking. A majority of studies have focused on chorioamnionitis complicating preterm deliveries, whereas only a few studies have investigated the potential impact of clinical and laboratory characteristics of term deliveries complicated by chorioamnionitis. Risk prediction models based on gestational age (14), duration of membrane rupture, highest maternal intrapartum temperature and timing of intrapartum antibiotic administration have been proposed (2, 3), but except for maternal intrapartum temperature, no study have investigated the association between clinical and laboratory characteristics of chorioamnionitis and risk of adverse neonatal outcomes at term gestation.
The aim of our study was therefore to describe clinical and laboratory characteristics of term deliveries complicated by chorioamnionitis. Moreover, we aimed at assessing the impact of these clinical and laboratory characteristics on the risk of adverse neonatal outcomes in term deliveries complicated by chorioamnionitis.