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Chorioamnionitis: the association between clinical and histological diagnosis
INFECTION classified as high risk for endometritis (any 2 factors): labor .12 hours, .4 vaginal examinations, ruptured membranes .9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A x2 analysis was used to test for differences in infection rates between groups (P , .05). Results: Of 1383 cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% (P 5 .056) as was the rate of endometritis (3.2% vs 1.2%, P 5 .185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P 5 .003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection (P 5 .13). Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.
Chorioamnionitis: the association between clinical and histological diagnosis Lawrence J. Gugino, MD, Paul T. Buerger, MD, Jean Wactawski-Wende, PhD, John Fisher, MD Department of Gynecology-Obstetrics, University at Buffalo, Buffalo, New York Objective: To determine the association between clinical and histological diagnoses of chorioamnionitis. Methods: A retrospective 9-year review of hospital records for all perinatal deaths (N 5 804) occurring at a Western New York regional perinatal center between 1988 and 1996 was conducted. Information concerning clinical indicators of chorioamnionitis were recorded including: maternal fever, leukocytosis, uterine tenderness, foul smelling discharge, and fetal tachycardia. Histological examination of the placenta was conducted in 797 of 804 perinatal deaths and staged by a standardized method. Type and number of clinical signs and symptoms were correlated with severity of histologic grade to determine their relation. Results: Chorioamnionitis was diagnosed either clinically or histologically in 243 (30.5%) of 797 perinatal deaths. Of these, 72 cases (23.5%) occurred in the 307 fetal deaths and 171 (34.9%) occurred in the 490 neonatal deaths. Five cases were diagnosed only on autopsy. In 51 of 243 cases (21%) there was histologic confirmation of chorioamnionitis without any clinical indicators present. In 13 of 243 cases (5.4%) there were 1 or more clinical indicators of chorioamnionitis without histologic confirmation. Sensitivity and specificity for 1 or more clinical indicators was 77.8% and 97.7%, respectively. Conclusion: Chorioamnionitis was present in 30.5% of perinatal deaths in this cohort. Identification of one or more clinical signs or symptoms was found to be both a sensitive and specific screening method for a presumptive diagnosis of 148
chorioamnionitis when using histologic confirmation as the gold standard.
Febrile morbidity and hospital stay in high-risk cesarian section patients at a non-teaching hospital Suresh I. Persad, MD, FACOG, FRCS(C) Assistant Clinical Professor OB GYN, MCG Candler General Hospital, Savannah, Georgia Objective: The objective of the study was to determine the incidence of postcesarian febrile morbidity and relate this to hospital stay in a high-risk indigent population treated at a private non-teaching hospital. Methods: This was a retrospective chart review of all patients done between January 1995 and December 1996. Discharge summaries, antepartums, progress notes, and labs were reviewed for each patient. Of 257 charts reviewed, 5 were inadequate for various reasons. Board-certified surgeons performed and assisted in the operations. Twenty-one patients had scant prenatal care and 6 had no prenatal care. All patients had the abdomen scrubbed with Betadine soap prior to painting. No shaving was done. Gloves were changed after closure of uterine incision. The pelvis was copiously irrigated with 3– 4 L of saline. The subcutaneous layer was irrigated from a height of 6 –120 with 1⁄2 to 1 L of fluid. After this step, this layer is not touched by anything from the operating field. Results: Of 162 patients with primary cesarian, 20 had postoperative fever, 18 with endometritis, 2 with wound infections. All but 5 of these patients had labor as ruptured membranes of 12 hours or more. Four had prolonged 2nd stage. Of 28 failed VBACs, 2 had fever vs none for 59 elective repeat cesarians. The average hospital stay for febrile patients was 4.4 days vs 2.7 for afebrile patients. The incidence of wound infection was 0.8%. The incidence of fever was 12.2% for primary cesarians and 8.8% in the total study group of 249 patients. Conclusion: This study demonstrates that the adoption of simple measures presented in Methods can dramatically decrease the incidence and severity of postcesarian fever, especially wound infection, thereby allowing safe, early hospital discharge.
Strategies to decrease costs associated with GBS prophylaxis in preterm gestations T. Nguyen, D.A. Guinn, A. Rodriguez, R. Mehendale, E.Q. Quillen, L.M. Albrecht University of Illinois at Chicago, Chicago, Illinois Objective: 1) To evaluate the costs associated with a practice of routinely culturing women for Group B b-Streptococcus Prim Care Update Ob/Gyns
Chorioamnionitis: the association between clinical and histological diagnosis Lawrence J. Gugino, MD, Paul T. Buerger, MD, Jean Wactawski-Wende, PhD, John Fisher, MD Department of Gynecology-Obstetrics, University at Buffalo, Buffalo, New York Objective: To determine the association between clinical and histological diagnoses of chorioamnionitis. Methods: A retrospective 9-year review of hospital records for all perinatal deaths (N 5 804) occurring at a Western New York regional perinatal center between 1988 and 1996 was conducted. Information concerning clinical indicators of chorioamnionitis were recorded including: maternal fever, leukocytosis, uterine tenderness, foul smelling discharge, and fetal tachycardia. Histological examination of the placenta was conducted in 797 of 804 perinatal deaths and staged by a standardized method. Type and number of clinical signs and symptoms were correlated with severity of histologic grade to determine their relation. Results: Chorioamnionitis was diagnosed either clinically or histologically in 243 (30.5%) of 797 perinatal deaths. Of these, 72 cases (23.5%) occurred in the 307 fetal deaths and 171 (34.9%) occurred in the 490 neonatal deaths. Five cases were diagnosed only on autopsy. In 51 of 243 cases (21%) there was histologic confirmation of chorioamnionitis without any clinical indicators present. In 13 of 243 cases (5.4%) there were 1 or more clinical indicators of chorioamnionitis without histologic confirmation. Sensitivity and specificity for 1 or more clinical indicators was 77.8% and 97.7%, respectively. Conclusion: Chorioamnionitis was present in 30.5% of perinatal deaths in this cohort. Identification of one or more clinical signs or symptoms was found to be both a sensitive and specific screening method for a presumptive diagnosis of 148
chorioamnionitis when using histologic confirmation as the gold standard.
Febrile morbidity and hospital stay in high-risk cesarian section patients at a non-teaching hospital Suresh I. Persad, MD, FACOG, FRCS(C) Assistant Clinical Professor OB GYN, MCG Candler General Hospital, Savannah, Georgia Objective: The objective of the study was to determine the incidence of postcesarian febrile morbidity and relate this to hospital stay in a high-risk indigent population treated at a private non-teaching hospital. Methods: This was a retrospective chart review of all patients done between January 1995 and December 1996. Discharge summaries, antepartums, progress notes, and labs were reviewed for each patient. Of 257 charts reviewed, 5 were inadequate for various reasons. Board-certified surgeons performed and assisted in the operations. Twenty-one patients had scant prenatal care and 6 had no prenatal care. All patients had the abdomen scrubbed with Betadine soap prior to painting. No shaving was done. Gloves were changed after closure of uterine incision. The pelvis was copiously irrigated with 3– 4 L of saline. The subcutaneous layer was irrigated from a height of 6 –120 with 1⁄2 to 1 L of fluid. After this step, this layer is not touched by anything from the operating field. Results: Of 162 patients with primary cesarian, 20 had postoperative fever, 18 with endometritis, 2 with wound infections. All but 5 of these patients had labor as ruptured membranes of 12 hours or more. Four had prolonged 2nd stage. Of 28 failed VBACs, 2 had fever vs none for 59 elective repeat cesarians. The average hospital stay for febrile patients was 4.4 days vs 2.7 for afebrile patients. The incidence of wound infection was 0.8%. The incidence of fever was 12.2% for primary cesarians and 8.8% in the total study group of 249 patients. Conclusion: This study demonstrates that the adoption of simple measures presented in Methods can dramatically decrease the incidence and severity of postcesarian fever, especially wound infection, thereby allowing safe, early hospital discharge.
Strategies to decrease costs associated with GBS prophylaxis in preterm gestations T. Nguyen, D.A. Guinn, A. Rodriguez, R. Mehendale, E.Q. Quillen, L.M. Albrecht University of Illinois at Chicago, Chicago, Illinois Objective: 1) To evaluate the costs associated with a practice of routinely culturing women for Group B b-Streptococcus Prim Care Update Ob/Gyns