Chorioamnionitis management Challenges, expectations, and reality - A descriptive study at maternity in Tunisia

Abstract

About 2-5% of pregnancies face a chorioamnionitis risk, which can be fatal, if coupled with preterm birth. The new discussions offer the word 'Triple I' that improves the accuracy and management of investigations. Nevertheless, its study is still limited in Tunisia.The objective of this study was to establish the diagnostic and therapeutic management of chorioamnionitis in pregnant women at various gestational ages and to determine the maternal and fetal consequences. METHODS This descriptive and retrospective longitudinal study was conducted at the Tunis Maternity and Neonatology Center from January 2020 to December 2021. All pregnant patients admitted to Services A and D were included in the study if the diagnosis of chorioamnionitis was made either in the emergency department or during hospitalization, regardless of the gestational age and the initial reason for hospitalization. Data were anonymously collected and analyzed looking at the mothers’ and newborns’ outcomes. RESULTS In 3280 hospitalizations, chorioamnionitis was in 1.4%. The majority of my patients were from the age group of primigravida (63%) and primiparous (69.5%). The mean diagnostic gestational age was 36.8 weeks. Diagnosis was performed based on clinical signs, which accounted for 80.4% of cases during hospitalization. Prominent clinical features include ruptured membranes in 76% cases, tinted amniotic fluid in 15.2%, maternal fever in 21.7% cases, uterine contractions in 52.1%, non-reassuring fetal heart rate recording in three patients (32%), and maternal tachycardia in two patients (4.3%). The most frequent association of symptoms observed was membranes rupture and fever (73.9%). Antibiotic therapy and pregnancy termination were the standard practice, and 32.6% of patients received corticosteroids. This included the cesarian section in 89.13% of the cases. The maternal complications comprised of endometritis (2.2%) and postpartum hemorrhage (2.2%). Neonatal mortality was 19.6% only, where the mortality rates were decreasing with increasing gestational age. The main adverse neonatal outcomes were pre-maturity (50%) and respiratory distress (30.6%).The study reveals that duration of hospital stay has a statistically meaningful relation to the time between the admission and diagnosis of chorioamnionitis (p = 0.004). The association between the Apgar score and fetal heart monitoring was not found to be of statistical significance (p = 0.760). This rate of neonatal death and complication was significantly affected by the birth weight and gestational age (p<0.001). The duration of hospital stays differed according to gestational age, with the advanced gestational ages related to the shorter hospital periods (Rho=-0.391, p=0.008). CONCLUSION The treatment of chorioamnionitis at the Tunis Maternity and Newborns Center is multifaceted and includes early diagnosis, antibiotic therapy, and pregnancy termination. There is an impact of gestational age on the maternal and neonatal outcomes hence early screening and management becomes imperative. This study underlines that there is a requirement for additional studies and standardized management approach for chorioamnionitis, to address resource challenges effectively.