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- W2029891768 abstract "Clinical chorioamnionitis (CHORIO) is associated with an increased risk of cesarean delivery (CD). We hypothesized that the development of hyperthermia and inflammation are followed by decreased uterine contractility and cesarean delivery for labor dysfunction. Retrospective data were abstracted by chart review from term subjects with CHORIO (T>100.4°F) concurrent with an IUPC (Years 2009-12). Montevideo units (MVUs), oxytocin dose (OXY) and other clinical information were abstracted hourly at Time 0 (first T>100.4°F) and in the 5 hour time blocks preceding and following. Uterine contractility with respect to time before fever, and time after fever were analyzed with linear regression independently. The results were adjusted for oxytocin dose and parity with a mixed effects model using the R programing language. 100 subjects were enrolled. Mean gestational age was 39.9 ± 1.2 weeks, median BMI was 31.5 (20-61), 86% were nulliparous, 17% were GBS+, and 99% received epidural analgesia. The final CD rate was 69%; 68% of CD was for dysfunctional labor. Funisitis was detected in 35.9% of samples sent (23/64). Uterine contractility significantly and steadily declined starting on average two hours following CHORIO Dx (p=0.03, Figure 1). The mean adjusted decrease was 6.9 ± 3.2 MVU/hr. Waning contractility was not due to falling OXY dosing, which remained flat. Oxytocin increased contractility 0.6 ± 0.1 MVU/unit before the diagnosis of CHORIO and 0.4 ± 0.1 MVU/unit after diagnosis (p<0.001). CHORIO is associated with a subsequent degradation in uterine contractility and a substantial rate of CD for labor dysfunction. Oxytocin is significantly less effective at stimulating uterine contractility following CHORIO. These data provide important guidance for intrapartum management; close attention should be given to assiduously maintaining adequate uterine contractions following a diagnosis of CHORIO. The likelihood of successful vaginal delivery appears to decrease over time.Figure 1. Uterine contractility and oxytocin dose relative to hours from diagnosis of intrapartum fever" @default.
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- W2029891768 date "2015-01-01" @default.
- W2029891768 modified "2023-09-24" @default.
- W2029891768 title "121: Clinical chorioamnionitis and uterine contractility" @default.
- W2029891768 doi "https://doi.org/10.1016/j.ajog.2014.10.167" @default.
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