Prevalence and Factors Associated With Histological Chorioamnionitis among Term Women Delivering From Mbarara Regional Referral Hospital

Abstract

Background: Chorioamninitis (CAM), is an acute inflammation of the membrane and chorion of the placenta which can either be clinical or histological. At Mbarara Regional Referral Hospital the prevalence and factors associated with histological chorioamnionitis are widely unknown. Objective: To assess the prevalence and factors associated with histological chorioamnionitis in term pregnancy among mothers delivering from Mbarara Regional Referral Hospital. Methods: At inclusion in a cross-section, from December 2015 to February 2016, 136 women at term were interviewed. The placentas were evaluated, and diagnosis was based on histologic examination of the placenta. Placentas with microscopic evidence of inflammation of the membranes (infiltration of polymorphonuclear leukocytes and other immunocytes, such as macrophages and T cells) were considered positive for histological chorioamnionitis (HCA). Placental positive for HCA were scored and categorized as: Grade 1 (mild to moderate chorioamninitis) or Grade 2 (severe chorioamnionitis- three or more chorionic microabscesses). Logistic regression was used to determine factors associated with chorioamnionitis. The significant level of 5% was used. Odds ratios and their corresponding 95% CI were provided at both bivariate and multivariate analysis. Results: Among the 129 placentas of mothers at term that were examined, histologogical chorioamnionitis was diagnosed (HCA-positive) in 34.1% of women. Duration of labor more than 18 hours was found to be associated with HCA (aOR=4.0, 95%CI:1.30-12.39, p=0.0267). There were 34 cases of HCA grade 1 among cases positive for HCA (81.8%). Conclusions: In our study, the prevalence of HCA was found to be high and duration of labor more than 18 hours was found to be significantly associated with HCA. The proportion of grade 1 HCA among term women with HCA at MRRH is 81.8%.