Management of Intraamniotic Infection After Spontaneous Vaginal Delivery: Is Nothing Really Enough? [24C]

Abstract

INTRODUCTION: Current guidelines for management of intraamniotic infection (IAI) call for intrapartum antibiotic therapy, without further treatment after spontaneous vaginal delivery (SVD) except in high-risk women. High-risk criteria are not well-defined. We aim to describe the incidence of and identify risk factors for postpartum infectious complications (PPI) after SVD complicated by IAI. METHODS: Case control study of SVDs with clinically diagnosed IAI at a single academic center. Cases were defined as women who developed PPI, including endometritis, perineal infection, sepsis, urinary tract infection (UTI), or pyelonephritis. Cases were compared to those who did not develop PPIs (controls) using bivariate statistics. IRB approval was obtained prior to commencement of this study. RESULTS: Between 01/01/2014 and 12/31/2017, 346 women underwent SVD complicated by IAI. Of these, 23 (6.2%) developed PPI (endometritis n=7, UTI/pyelonephritis n=6, sepsis n=4, perineal infection n=6) within 6 weeks of delivery. No differences in demographic data or antepartum complications were observed. Women with PPI were not more likely to receive antibiotics intra- or postpartum, however were more likely to deliver prior to 32 weeks (17.4% vs 4.9%, P=.04). When controlling for antibiotic use intra- and postpartum, delivery at <32 weeks was associated with 3.8-fold increased (95% CI 1.07, 13.7) odds of PPI. CONCLUSION: Postpartum infectious complications occur in approximately 1/15 women delivering vaginally with IAI, with those who deliver at <32 weeks' gestation being at increased risk. Though no specific guidelines for postpartum antibiotic therapy in the setting of IAI exist, women delivering before 32 weeks may warrant consideration of postpartum antimicrobial therapy.