Intraamniotic Infection Rates after Intrauterine Pressure Catheter with and without Amnioinfusion

Abstract

Objective This study aimed to examine the rates of intraamniotic infection between intrauterine pressure catheter with amnioinfusion and intrauterine pressure catheter alone.

Study Design This was a retrospective cohort study of all women who had an intrauterine pressure catheter placement during labor at a tertiary referral hospital from January 2016 to June 2018. Outcomes were compared between women who had an intrauterine pressure catheter with amnioinfusion and intrauterine pressure catheter placement alone. The primary outcome was the rate of intraamniotic infection. Secondary outcomes included postpartum endometritis, postpartum hemorrhage (blood loss of ≥1,000 mL), quantitative blood loss (mL), and cesarean delivery. Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (aOR) and 95% confidence interval (95% CI), controlling for age, race, body mass index, gestational age, and length of time of rupture of membranes.

Results Of 1,268 women with an intrauterine pressure catheter, 298 (23.5%) also had an amnioinfusion. Women who had amnioinfusion through an intrauterine pressure catheter compared with those who had intrauterine pressure catheter alone had similar rates of intraamniotic infection (5.4 vs. 8.0%, crude p = 0.12, aOR 0.69; 95% CI 0.39–1.21), as well as secondary outcomes such as postpartum endometritis (3.0 vs. 2.5%, crude p = 0.61, aOR 1.12; 95% CI 0.49–2.53), postpartum hemorrhage (16.1 vs. 15.8%, crude p = 0.89, aOR 1.07; 95% CI 0.75–1.54), blood loss (479.5 vs. 500 mL, adjusted p = 0.89), and cesarean delivery (40.6 vs. 43.1%, crude p = 0.45, aOR 0.90; 95% CI 0.68–1.19).

Conclusion Amnioinfusion was not associated with increased odds of intraamniotic infection compared with intrauterine pressure catheter placement alone.

Key Points

• Amnioinfusion involves instilling fluid into the amniotic cavity to relieve variable decelerations.

• Amnioinfusion is not associated with increased odds of chorioamnionitis compared to IUPC alone.

• Amnioinfusion is not associated with increased odds of PPH compared to IUPC placement alone.

Keywords

amnioinfusion - intrauterine pressure catheter - intraamniotic infection - chorioamnionitis - postpartum hemorrhage

Note

The results of this study were presented as an oral and poster presentation at the SMFM 40th Annual Meeting—The Pregnancy Meeting, Grapevine, TX (February 3 to 8, 2020).

Publikationsverlauf

Eingereicht: 12. Mai 2020

Angenommen: 07. Juli 2020

Artikel online veröffentlicht:
13. August 2020

• References

• 1 Regi A, Alexander N, Jose R, Lionel J, Varghese L, Peedicayil A. Amnioinfusion for relief of recurrent severe and moderate variable decelerations in labor. J Reprod Med 2009; 54 (05) 295-302
• 2 Bakker JJ, Jansenn PF, van Halem K. et al. Internal versus external tocodynamometry during induced or augmented labor. Cochrane Database Sys Rev 2012; 12: CD006947
• 3 Lind BK. Complications caused by extramembranous placement of intrauterine pressure catheters. Am J Obstet Gynecol 1999; 180 (04) 1034-1035
• 4 Matsuo K, Lynch MA, Kopelman JN, Atlas RO. Anaphylactoid syndrome of pregnancy immediately after intrauterine pressure catheter placement. Am J Obstet Gynecol 2008; 198 (02) e8-e9
• 5 Harper LM, Shanks AL, Tuuli MG, Roehl KA, Cahill AG. The risks and benefits of internal monitors in laboring patients. Am J Obstet Gynecol 2013; 209 (01) 38.e1-38.e6
• 6 Nuttall ID. Perforation of a placental fetal vessel by an intrauterine pressure catheter. Br J Obstet Gynaecol 1978; 85 (08) 573-574
• 7 Mao Y, Pierce J, Singh-Varma A, Boyer M, Kohn J, Reems JA. Processed human amniotic fluid retains its antibacterial activity. J Transl Med 2019; 17 (01) 68
• 8 Schlievert P, Johnson W, Galask RP. Amniotic fluid antibacterial mechanisms: newer concepts. Semin Perinatol 1977; 1 (01) 59-70
• 9 Rouse DJ, Landon M, Leveno KJ. et al; National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network. The maternal-fetal medicine units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (01) 211-216
• 10 Shatrov JG, Birch SC, Lam LT, Quinlivan JA, McIntyre S, Mendz GL. Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol 2010; 116 (2 Pt 1): 387-392
• 11 Hauth JC, Gilstrap III LC, Hankins GD, Connor KD. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol 1985; 66 (01) 59-62
• 12 Practice bulletin 183: postpartum hemorrhage. Am Coll Obstet Gynecol 2017; 130: e168-e186
• 13 American College of Obstetricians and Gynecologists. Committee Opinion 712. Intrapartum Management of Intraamniotic Infection. Obstet Gynecol 2017; 130: e95-e101
• 14 Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37 (02) 339-354
• 15 Gee SE, Ma'ayeh M, Ward C. et al. Intrauterine pressure catheter use is associated with an increased risk of postcesarean surgical site infections. Am J Perinatol 2020; 37 (06) 557-561
• 16 Bhatia P, Reena K, Nangia S. Role of intrapartum transcervical amnioinfusion in patients with meconium-stained amniotic fluid. J Obstet Gynaecol India 2013; 63 (01) 59-63