Diagnosis and Treatment of Chorioamnionitis- Quality Assurance Study
CPS ePoster Library. Leader J. Jun 1, 2017; 176595; 34
Jordana Leader
Jordana Leader
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Abstract
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Background: Chorioamnionitis is an intrapartum condition with the potential for significant maternal and neonatal morbidity and mortality. The diagnosis of chorioamnionitis also results in broad-spectrum antibiotics being administered, which can affect the neonatal microbiome. By standardizing the diagnosis we are hoping to continue to improve the judicious use of antibiotics in patients. We are not aware of any hospital protocols in Ontario that incorporate factors associated with chorioamnionitis into a clinical pathway for diagnosis.

Objectives: The primary objective was to evaluate the percentage of cases of chorioamnioits that met the clinical patway criteria pre and post implementatino of the patway. Our secondary objectives were to determine whether materal and neonatal outcomes were different between those who met and did not meet criteria, as well as to analyze data on the primary maternal antibiotic choices, timeline of administration and duration of treatment when maternal chorioamnionitis is diagnosed in the intrapartum period.

Methods: Charts for review prior to the implementation of the order set was collected for the time period between January 2013-January 2014. Charts for review after the implementation of the order set will be collected for the time period between January 2015-January 2016. Fifty charts were reviewed for each time period. Maternal charts will be identified from St. Joseph's healthcare Hamilton health records on the basis of a diagnosis of intrapartum maternal fever and/or chorioamnionitis.

Results: Prior to implementation, out of 50 of the charts pulled for suspected chorioamnionitis only 34 (68%) met the agreed upon definition of chorioamnionitis. Post implementation, 82% met the agreed upon definition. In the majority of cases, both pre and post implementation, fetal tachycardia was the major factor present at diagnosis. Pre implementation patients were mostly given ampicillin and gentamicin (68%) while most patients post implementation (96%) were given ceftriaxone and flagyl. There was 24% admission rate to the NICU for those patients that met the pathway diagnosis of chorioamnionitis and 8% admission for those that did not meet the criteria (OR=0.33).

Conclusion: The implementation of the clinical pathway has resulted in a more consistent diagnosis and management of chorioamnionitis. Neonates whose mother were diagnosed with chorioamnionitis meeting the pathway definition were admitted at higher rates to the NICU.

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