title: Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes.
abstract: OBJECTIVE
  To compare morbidities of neonates born to women who developed chorioamnionitis after premature preterm rupture of membranes versus those who did not.
  
  
  METHODS
  We reviewed outcomes in singleton pregnancies with confirmed premature preterm rupture of membranes at 24 weeks or beyond that resulted in delivery less than 37 weeks. Management of premature preterm rupture of membranes included the use of antibiotics, betamethasone if less than 32 weeks, and expectant management with induction at 34 weeks or greater. Composite neonatal major and minor morbidity rates were compared between pregnancies complicated by chorioamnionitis and those that were not.
  
  
  RESULTS
  From August 1998 to August 2000, 430 cases of premature preterm rupture of membranes were identified among 6003 deliveries (7.2%). Thirteen percent of women (56/430) with premature preterm rupture of membranes developed chorioamnionitis. The incidence of chorioamnionitis increased significantly with decreasing gestational age. The composite neonatal major morbidity rate was significantly higher in neonates whose mothers developed chorioamnionitis (55%) versus those who did not (18%, P < .0001). In a multiple logistic regression model, chorioamnionitis ( P < .0001), infant gender ( P = .007), latency ( P = .03), and gestational age at delivery ( P < .0001) were significantly associated with composite neonatal morbidity.
  
  
  CONCLUSIONS
  Neonatal morbidities are significantly higher among pregnancies with premature preterm rupture of membranes complicated by chorioamnionitis when compared with pregnancies that were not.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics/Gynecology, 458 Old Hillman Building, 619 19th St South, Birmingham, AL, USA. ramsey_patrick@hotmail.com
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Ramsey
authors.forename: Joelle M
authors.initials: JM
authors.lastname: Lieman
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Brumfield
authors.forename: Waldemar
authors.initials: W
authors.lastname: Carlo
mesh_terms: D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D016022:Case-Control Studies; D002821:Chorioamnionitis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000453:epidemiology*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index