EVALUATION OF A CLINICAL PROTOCOL FOR THE MANAGEMENT OF FEVER IN LABOR IN PREGNANT WOMEN AT TERM: A PRE-POST COHORT STUDY

Objectives Chorioamnionitis occurs in about 1-13% of term pregnancies and can result in serious maternal and neonatal complications. Often over-diagnosed due to the heterogeneity of clinical manifestations, it can lead to unnecessary investigations and treatments and longer hospitalization. The aim of this study was to compare the incidence of clinical chorioamnionitis and the accuracy of its diagnosis before and after implementing a clinical protocol for the management of fever in labor based on the SOGC guidelines. The use of antibiotics and the maternal and neonatal outcomes were also compared. Methods In a tertiary care center, during the year prior to the implementation of the clinical protocol, all diagnosed cases of clinical chorioamnionitis in term pregnancies (n=178) were retrospectively reviewed. All cases diagnosed in the first year after its implementation (n=138) were also reviewed. The two periods were compared using bivariate analyses. Results Incidence of clinical chorioamnionitis decreased from 7% to 4% birth-year (p Conclusions The use of a clinical protocol for the management of fever in labor increases the diagnostic accuracy of clinical chorioamnionitis and decreases the use of antibiotics in term pregnancies. This tool significantly contributed to diminish the incidence of this condition, while maintaining the level of maternal and neonatal peri-partum complications low.