Epidural use and clinical chorioamnionitis among women who delivered vaginally.
OBJECTIVE
Chorioamnionitis, an important cause of maternal and neonatal morbidity, is influenced by epidural use and the occurrence of epidural fever. We evaluated the association between chorioamnionitis, histologic placental findings, and intrapartum factors focusing on epidural use.


METHODS
We conducted a secondary analysis of a randomized controlled trial of different doses of oxytocin to prevent postpartum hemorrhage among women who delivered vaginally. The primary outcome was clinical diagnosis of chorioamnionitis leading to antibiotic therapy. Intrapartum factors examined included epidural use, parity, labor induction, gestational age, maternal age, ethnicity, body mass index, cervical dilatation at admission, preeclampsia/eclampsia, preterm labor, and duration of labor.


RESULTS
Of the 1,798 women randomized, we excluded 13 multifetal births leaving 1,785 for analysis: 1,491 had an epidural and 294 did not. Of those with epidural, 8.0% had clinically diagnosed chorioamnionitis compared with only 1.0% without epidural: unadjusted odds ratio (OR) = 8.3 (95% confidence interval [CI]: 2.63-26.40); p < 0.0001. After multivariable logistic regression, epidural use (adjusted OR: 5.80; 95% CI: 1.77-19.11), increasing parity (0.42; 0.32-0.55), and preeclampsia (0.31; 0.14-0.66) were significantly associated with chorioamnionitis.


CONCLUSIONS
Epidural use is statistically associated with an increase in clinical diagnosis of chorioamnionitis. A cause and effect relationship cannot be confirmed from this study. Independently of labor duration and increasing parity, preeclampsia appeared protective.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Adi
A
Abramovici
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
Jeff M
JM
Szychowski
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Joseph R
JR
Biggio
Department of Anesthesia, University of Alabama at Birmingham, Birmingham, Alabama.
Yasser
Y
Sakawi
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
William W
WW
Andrews
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Alan T N
AT
Tita
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002821:Chorioamnionitis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D055815:Young Adult