Risk factors for neonatal sepsis in offspring of women with prelabor rupture of the membranes at 34-42 weeks.
One thousand three hundred eighty-five women with PROM (prelabor rupture of the membranes) participated in a prospective randomized study. Women with PROM were randomized to induction the following morning after PROM (early induction group) or induction two days later (late induction group). If contractions started within 2 hours after admission these women were included in the short latency group. All neonatal infections were classified as verified sepsis (positive culture) or clinical sepsis. The aim of the study was to compare the perinatal infectious outcome between the groups with different expectant managements in women with PROM and to study the association between demographic, intrapartum and postpartum variables and neonatal sepsis. In the short latency group one neonate had a proven sepsis while four neonates with proven sepsis were found in the early induction group. No proven sepsis was detected in the late induction group. Univariate analyses showed a significant association between clinical sepsis and: induction of labor (OR = 2.94, 95% CI 1.30-6.68), established labor 24.1-32 hours after ROM (OR = 5.89, 95% CI 1.68-20.63), established labor > 32 hours after ROM (OR = 4.59, 95% CI 1.52-13.87), time from ROM to delivery > 32 hours (OR = 5.07, 95% CI 1.40-18.39), cesarean section (OR = 11.03, 95% CI 4.10-29.68), chorioamnionitis before or during delivery (OR = 27.14, 95% CI 2.38-309.16), endometritis (OR = 18.08, 95% CI 1.82-179.87), CRP over 20 mg/l in the umbilical cord (OR = 17.12, 95% CI 5.68-52.12) and Apgar score < 7 after 1, 5 or 10 minutes. In a stepwise logistic regression analysis a significant association was found between clinical sepsis and cesarean section (OR = 10.08, 95% CI = 3.26-31.20), time from ROM to delivery > 32 h (OR = 3.74, 95% CI 1.62-8.62), gestational age 34-36 weeks (OR = 3.16, 95% CI 1.11-8.96) and parous women (OR = 2.41, 95% CI 1.04-5.57). In conclusion, this study indicates that that there was no difference in the incidence of neonatal infections between those with early and late induction. Clinical neonatal sepsis was associated with time from PROM to delivery over 32 hours, cesarean section, parous women and gestational age between 34 and 36 weeks.
Ladfors
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Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg University, Sweden. lars.ladfors@sahlgrenska.se
Tessin
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Mattsson
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Eriksson
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Seeberg
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Fall
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D001034:Apgar Score; D001424:Bacterial Infections / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002821:Chorioamnionitis / Q000150:complications; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D007743:Labor, Obstetric; D011247:Pregnancy; D012307:Risk Factors; D013203:Staphylococcal Infections; D013290:Streptococcal Infections; D013997:Time Factors
D002097:C-Reactive Protein