Suspected Chorioamnionitis and Myometrial Contractility: Mechanisms for Increased Risk of Cesarean Delivery and Postpartum Hemorrhage

Reproductive Sciences
Alyssa ZacklerLaura Goetzl

Abstract

Chorioamnionitis is associated with an increased risk of cesarean delivery and uterine atony. We hypothesized that the onset of maternal fever is temporally associated with decreased uterine contractility. Retrospective cohort. Academic center. Term participants who developed a fever in the setting of an intrauterine pressure catheter. Montevideo units (MVUs) and oxytocin dose at time 0 (first oral temperature ≥38°C) and in the five 1--hour blocks preceding and following T0. Montevideo units relative to the onset of fever. Results were adjusted for oxytocin dose and parity in a mixed-effects model. One hundred participants were included. Uterine contractility was maintained for 2 hours after the onset of maternal fever but thereafter significantly and steadily declined by an average of 6.9 ± 3.2 MVU/h ( P = .03), despite the absence of a parallel decline in oxytocin exposure. Multiparas and nulliparas showed a similar pattern of waning uterine contractility. Patients who delivered vaginally maintained contractility, while those who delivered via cesarean had diminishing contractility ( P = .01). The postpartum hemorrhage (PPH) rate (postpartum bleeding requiring treatment) was 32%. A decline in myometrial contractility occurs 2...Continue Reading

References

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Citations

Mar 27, 2020·Research and Practice in Thrombosis and Haemostasis·Lian LancasterAnnette von Drygalski
Dec 6, 2020·Obstetrics and Gynecology·Hayley E MillerDeirdre J Lyell
Feb 19, 2021·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Diana A RacusinSuneet P Chauhan
Feb 25, 2021·Obstetrical & Gynecological Survey·Emma S RyanSarah Dotters-Katz
Oct 3, 2020·American Journal of Obstetrics and Gynecology·Agustin Conde-AgudeloÁngel José Garcia Sánchez
Nov 6, 2021·American Journal of Obstetrics and Gynecology·Ariel SklarStephanie B Teal
Jan 19, 2021·BJA Education·C J Mullington, S Malhotra

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