Chorioamnionitis in the preterm gestation.

Two hundred fifty-one patients with premature rupture of membranes between 28 and 34 weeks' gestation were followed prospectively to evaluate the maternal and neonatal effects of chorioamnionitis. Forty-seven (19%) developed intrauterine infection prior to delivery. Fetal tachycardia, maternal leukocytosis, and uterine contractions were not predictive of intrauterine infection in afebrile patients. In afebrile patients, however, amniocenteses positive for bacteria on Gram stains and/or with subsequent positive culture correlated with subsequent development of antenatal maternal fever. Other than an increased rate of postpartum endometritis no serious maternal complications were seen in patients with chorioamnionitis. Neonatal outcome, however, was significantly adversely affected with respect to increase in perinatal mortality, overall neonatal infection rate, and respiratory distress syndrome (RDS) in patients with maternal infection. Neither trial of labor nor duration of labor in patients with chorioamnionitis correlated with adverse neonatal outcome. However, the appearance of maternal fever prior to the onset of labor correlated more significantly with neonatal death and RDS in the newborn that did the development of maternal fever in the intrapartum period.