Risk Factors for Histologic Chorioamnionitis Among Women with Prenatal Fever During Preterm Delivery: A Retrospective Cohort Study
Year: 2025
Type: article
Abstract: Nan Lin,1,2,* Yiru Shi,1,2,* Yuanqing Xia,1,2 Yunfan Yang,1,2 Renyi Hua1,2 1Department of Obstetrics, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China; 2Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, People’s Republic of China*These authors contributed equally to this workCorrespondence: Renyi Hua, Email [email protected] and Objective: Histologic chorioamnionitis (HCA) complicates preterm birth and adversely affects neonatal and maternal outcomes; however, early recognition remains challenging. Here, we aimed to identify risk factors for HCA and assess its impact on pregnancy outcomes in preterm deliveries with prenatal fever.Design: Retrospective cohort analysis.Setting: Tertiary obstetrics and Gynecology Hospital in Shanghai, China.Participants: A total of 220 women who delivered preterm (gestational age < 37 weeks) with prenatal fever between January 2018 and December 2020 were ultimately included in the study. This included an HCA group (101 cases) and control group (119 cases).Main Outcome Measures: HCA diagnosis by placental pathology; neonatal outcomes.Results: The incidence of congenital infection (27.66 vs 15.38%, P=0.029) and neonatal sepsis (8.89 vs 0.90%, P=0.017) was significantly greater in the HCA group than in the control group. Fever interval and PROM between 24 to 48 h (aOR=3.603, 95% CI 1.027~12.644) and > 48 h (aOR=6.201, 95% CI 1.729~22.238) were associated with HCA. A maternal WBC count ≥ 11× 109/L demonstrated a sensitivity of 80%, a specificity of 46%, a positive predictive value of 56.3%, and a negative predictive value of 73.3% for HCA prediction. A maternal white blood cell count ≥ 11× 109/L demonstrated optimal discriminatory power for HCA (AUC=0.667, 95% CI 0.569~0.738).Conclusion: HCA significantly increases the risks of neonatal sepsis and congenital infection in preterm infants. A prolonged PPROM-fever interval (> 24 h) and a maternal WBC ≥ 11× 109/L are key predictive factors for the need for active obstetric intervention. This study provides evidence-based cutoff values for clinical decision-making in preterm pregnancies with fever, potentially improving maternal and neonatal outcomes through timely intervention.Plain Language Summary: 1.The study identified clinically relevant risk factors, including the novel finding of an optimal WBC cutoff value (11× 109/L) for predicting histological chorioamnionitis, which could assist obstetricians in early clinical decision-making.The study performed multiple logistic regression analysis to control for potential confounders, providing robust evidence for the association between various maternal factors and histological chorioamnionitis.The single-center design limits the generalizability of our findings, as practices and patient populations may vary across different institutions and regions.The observational retrospective design prevents establishment of causal relationships and may introduce unmeasured confounding factors despite our statistical adjustments.Keywords: histologic chorioamnionitis, prenatal fever, preterm birth, preterm premature rupture of membranes
Authors: Lin N, Shi Y, Xia Y, Yang Y, Hua R
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7094977370
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