INTERNATIONAL MULTICENTER TERM PRELABOR RUPTURE OF MEMBRANES STUDY - EVALUATION OF PREDICTORS OF CLINICAL CHORIOAMNIONITIS AND POSTPARTUM FEVER IN PATIENTS WITH PRELABOR RUPTURE OF MEMBRANES AT TERM

OBJECTIVES: Our purpose was to determine significant predictors for th e development of clinical chorioamnionitis and postpartum fever in pat ients with prelabor rupture of membranes at term. STUDY DESIGN: Logist ic regression analysis with odds ratios and 95% confidence intervals w as used to determine the significant predictors of clinical chorioamni onitis and postpartum fever in women with prelabor rupture of membrane s at term enrolled in this study. The study recently compared in a ran domized controlled trial four strategies of management: induction with oxytocin, induction with prostaglandin, expectant management, and, if failed, induction with oxytocin or prostaglandin. RESULTS: The follow ing variables were significantly associated with clinical chorioamnion itis: (1) number of digital vaginal examinations: >8, 7 to 8, 5 to 6, 3 to 4 (vs 0 to 2) (odds ratio 5.07, 3.80, 2.62, 2.06); (2) duration o f active labor: greater than or equal to 12, 9 to <12, 6 to <9 hours ( vs <3 hours) (odds ratio 4.12, 2.94, 1.97); (3) meconium-stained amnio tic fluid (odds ratio 2.28); (4) parity, of 0 (odds ratio 1.80); (5) l ime from membrane rupture to active labor: greater than or equal to 48 , 24 to <48 hours (vs <12 hours) (odds ratio 1.76, 1.77); and (6) grou p B streptococcal colonization (odds ratio 1.71). Variables significan tly associated with postpartum fever were (I) clinical chorioamnioniti s (odds ratio 5.37), (2) duration of active labor: greater than or equ al to 12, 9 to greater than or equal to 12, 6 to <9, 2 to <6 hours (vs <3 hours) (odds ratio 4.86, 3.53, 3.46, 3.04), (3) cesarean section, operative vaginal delivery (odds ratio 3.97, 1.86), (4) group B strept ococcal colonization (odds ratio 1.88), and (5) maternal antibiotics b efore delivery (odds ratio 1.94). CONCLUSIONS: Increasing numbers of d igital vaginal examinations, longer duration of active labor, and meco nium staining of the amniotic fluid were the most important risk facto rs for the development of clinical chorioamnionitis in women with prel abor rupture of membranes at term. The most important risk factors for the development of postpartum fever were clinical chorioamnionitis, i ncreasing duration of active labor, and cesarean section delivery.