Suspected clinical chorioamnionitis with peak intrapartum temperature <38C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome.

Background: Chorioamnionitis (CA) affects up to 3.9% of all deliveries worldwide and is one of the leading causes of early-onset neonatal sepsis. Fever≥38C is an essential criterion for the diagnosis of clinical CA. Obstetricians frequently take the maternal risk factors into consideration, and many mothers are treated as CA even with peak intrapartum temperature (PIT) between 37.6C to 37.9C if they have other clinical signs and risk factors.

Aim: To estimate the prevalence of confirmed chorioamnionitis and adverse neonatal outcomes among those mothers with PIT below 38C.

Materials And Methods: Retrospective chart review among mothers delivered at Al-Wakra Hospital, Qatar, between1January2016 to 31December 2019 with a clinical suspicion of CA.

Results: Among 21,471 mothers, 442 were suspected of having CA (2.06%, 95% CI 1.88 to 2.26%). After exclusions, 415 were included in the study, 203(48.9%) mothers had PIT between 37.6-37.9C. There was no significant difference in the rate of confirmed CA between the low (<38C) and higher (≥38C) temperature groups (25.4%Vs.31.3%, OR0.75, 95%CI0.46-1.25 , p.262). More patients in the low-temperature group received paracetamol for PIT between 37.6 to 37.9 C, while it was less frequently used for such milder elevation in higher temperature group (88.2%Vs.38.9%, OR11.69, 95% CI 6.46-2.15, p <.001).

Conclusion: The incidence of suspected clinical CA in our institution was within the international rates. Although nearly half of the mothers with suspected clinical CA had peak temperature below the recommended diagnostic criteria, the rate of confirmed CA and neonatal outcome was not significantly different from those with PIT≥38C. Early antipyretic use might have affected further elevation of temperature.