title: Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes.
abstract: OBJECTIVE
  To determine whether ripening and induction in patients with term premature rupture of membranes (PROM) via intracervical balloon placement (ICB) increases the risk of chorioamnionitis when compared to women with term PROM ripened and induced with other methods.
  
  
  METHODS
  A retrospective cohort study of term singleton gestations undergoing ripening and induction after PROM between July 2009 and June 2012 was conducted. Exposure of interest was ICB placement. Primary outcome of interest was chorioamnionitis. Statistical analysis included bivariate and multivariate techniques.
  
  
  RESULTS
  Of 124 term PROM patients, 42 were ripened by ICB with or without oxytocin (33.9%) and 82 were ripened and induced with oxytocin (66.1%). More women ripened with an ICB were nulliparous (n = 35, 83.3% ICB versus n = 44, 53.7% oxytocin, p = 0.001). Chorioamnionitis was slightly more common in women ripened with ICB and/or oxytocin versus oxytocin alone but difference did not reach statistical significance (p = 0.10). The rate of cesarean delivery, intrauterine pressure catheter (IUPC) use, and median lengths of membrane rupture and active labor were higher in the ICB group. After adjustment, chorioamnionitis was not correlated with ICB placement but with nulliparity [AOR 12.5 (1.36, 114.6), p = 0.03] and IUPC use [AOR 4.39 (1.04, 18.5), p = 0.04].
  
  
  CONCLUSIONS
  Nulliparity and IUPC, not ICB placement, were associated with chorioamnionitis.
authors.affiliation: a Department of Obstetrics and Gynecology and.
authors.forename: Irena B
authors.initials: IB
authors.lastname: Cabrera
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Lehigh Valley Health Network, University of South Florida Morsani College of Medicine , Allentown , PA , USA.
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Quiñones
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Lehigh Valley Health Network, University of South Florida Morsani College of Medicine , Allentown , PA , USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Durie
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Lehigh Valley Health Network, University of South Florida Morsani College of Medicine , Allentown , PA , USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rust
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Lehigh Valley Health Network, University of South Florida Morsani College of Medicine , Allentown , PA , USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Smulian
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Lehigh Valley Health Network, University of South Florida Morsani College of Medicine , Allentown , PA , USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Scorza
mesh_terms: D000328:Adult; D020070:Cervical Ripening; D002821:Chorioamnionitis / Q000209:etiology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects* / Q000295:instrumentation*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cervical ripening; chorioamnionitis; induction of labor; intracervical balloon