A First Look at Chorioamnionitis Management Practice Variation among US Obstetricians

Table 1

Questions on diagnostic and treatment strategies.

Describe your most common strategy for diagnosing intrapartum chorioamnionitis.
□ Elevated temperature alone
□ Elevated temperature plus at least one additional sign or symptom
□ Elevated temperature plus at least two additional signs or symptoms
□ At least one sign or symptom alone without elevated temperature
□ Other:
What temperature is your threshold for diagnosing intrapartum chorioamnionitis?
□ 37.8°C (100.0°F)
□ 37.9°C (100.2°F)
□ 38.0°C (100.4°F)
□ 38.1°C (100.6°F)
□ 38.2°C (100.8°F)
□ Other:
What strategies do you use to lower maternal temperature before deciding whether a patient meets diagnostic criteria for chorioamnionitis? Choose all that apply.
□ None
□ IV fluid bolus
□ PO hydration
□ Tylenol or other antipyretics
□ External cooling (application of ice or cool cloths)
□ Other:
If a patient has a fever alone, with no additional signs or symptoms of chorioamnionitis, is it likely that your decision to treat for chorioamnionitis would be influenced by whether the patient has an epidural?
□ No
□ Yes, I would be more likely to diagnose chorioamnionitis and treat accordingly in a patient with a fever and an epidural than one without an epidural
□ Yes, I would be less likely to diagnose chorioamnionitis and treat accordingly in a patient with a fever and an epidural than one without an epidural
Do you think your institution's policy on neonatal sepsis workup influences how frequently you diagnose maternal chorioamnionitis?
□ No
□ Yes, I am more likely to diagnose maternal chorioamnionitis because of my institution's policy on neonatal sepsis workup
□ Yes, I am less likely to diagnose maternal chorioamnionitis because of my institution's policy on neonatal sepsis workup
What is the most common antibiotic regimen you use for treating intrapartum chorioamnionitis?*
□ Ampicillin
□ Azithromycin
□ Ancef (Cefazolin)
□ Cefotetan
□ Cefoxitin
□ Clindamycin
□ Ertapenem
□ Gentamicin, daily dosing
□ Gentamicin, TID dosing
□ Metronidazole
□ Unasyn (Ampicillin/sulbactam)
□ Zosyn (Piperacillin/tazobactam)
□ Ampicillin plus Gentamicin, daily dosing
□ Ampicillin plus Gentamicin, TID dosing
□ Ampicillin plus Gentamicin daily dosing plus Clindamycin
□ Ampicillin plus Gentamicin TID dosing plus Clindamycin
□ Other:
What is the most common antibiotic regimen you use for treating intrapartum chorioamnionitis in the setting of cesarean delivery?*
□ Same regimen as above
□ Different regimen (please check all that apply):
□ Ampicillin
□ Azithromycin
□ Ancef (Cefazolin)
□ Cefotetan
□ Cefoxitin
□ Clindamycin
□ Ertapenem
□ Gentamicin, daily dosing
□ Gentamicin, TID dosing
□ Metronidazole
□ Unasyn (Ampicillin/sulbactam)
□ Zosyn (Piperacillin/tazobactam)
□ Ampicillin plus Gentamicin, daily dosing
□ Ampicillin plus Gentamicin, TID dosing
□ Ampicillin plus Gentamicin daily dosing plus Clindamycin
□ Ampicillin plus Gentamicin TID dosing plus Clindamycin
□ Other:
What is your strategy for postpartum treatment after a vaginal delivery, in women diagnosed with intrapartum chorioamnionitis, in the absence of endometritis?
□ No additional antibiotics after delivery
□ One additional dose of antibiotics after delivery
□ Continue antibiotics for 24 hours after delivery
□ Continue antibiotics for 48 hours after delivery
□ Continue antibiotics for 24 hours after last fever
□ Continue antibiotics for 48 hours after last fever
□ Other:
What is your strategy for postpartum treatment after a cesarean delivery, in women diagnosed with intrapartum chorioamnionitis, in the absence of endometritis?
□ No additional antibiotics after delivery
□ One additional dose of antibiotics after delivery
□ Continue antibiotics for 24 hours after delivery
□ Continue antibiotics for 48 hours after delivery
□ Continue antibiotics for 24 hours after last fever
□ Continue antibiotics for 48 hours after last fever
□ Other:
Do you treat with oral antibiotics after a patient has finished her postpartum course of IV antibiotics?
□ Yes
□ No

∗Responses were not limited to one of the choices listed but rather one or more than one antibiotic choice as needed to accurately reflect respondents’ primary regimen.