title: A first look at chorioamnionitis management practice variation among US obstetricians.
abstract: Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
authors: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lucile Packard Children's Hospital at Stanford, Stanford University, 300 Pasteur Drive HH333, Stanford, CA 94305, USA. mbgreenberg@yahoo.com
authors: Mara B
authors: MB
authors: Greenberg
authors: Britta L
authors: BL
authors: Anderson
authors: Jay
authors: J
authors: Schulkin
authors: Mary E
authors: ME
authors: Norton
authors: Natali
authors: N
authors: Aziz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002821:Chorioamnionitis / Q000175:diagnosis / Q000628:therapy*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents