Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes.

Background: Premature rupture of membrane (PROM), especially when preterm or prolonged is associated with an increased risk of chorioamnionitis with its attendant feto-maternal complications. Aim: The study was aimed to determine the association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with PROM. Materials and Methods: Eligible participants with clinical diagnosis of PROM at gestational age of ≥28 weeks managed between December 2018 and June 2019 were consecutively recruited. Their sociodemographic characteristics, obstetrics history, and evidence of clinical chorioamnionitis using the Gibb's criteria were obtained. Following delivery, chorioamnionitis was histologically confirmed. Primary outcome measure was the proportion of women with PROM and histological chorioamnionitis that were detected clinically. Results: Of the 136 participants analyzed, 108 (79.4%) had term PROM, while 28 (20.6%) had preterm PROM (<37 weeks). The prevalence of histological chorioamnionitis was 50.0% compared to 16.2% using clinical indicators of infection. Histological chorioamnionitis was almost two times higher in preterm than term PROM (71.4% vs 38.9%). About two-third (67.6%) of the chorioamnionitis identified histologically were missed using clinical signs of chorioamnionitis. Clinical signs of chorioamnionitis had specificity of 100.0%, but low sensitivity (35.5%) and accuracy of 70.6%. A combination of three symptoms, maternal pyrexia and tachycardia, and fetal tachycardia appears to be the most reliable clinical indicator of chorioamnionitis in women with preterm PROM. There was a significant association between low birth weight, low Apgar score, NICU admission, and the presence of histological chorioamnionitis in women that had PROM. Conclusion: Clinical signs of chorioamnionitis have a low sensitivity and are not very accuracy in diagnosing chorioamnionitis in women with PROM.

Acceptance of postpartum intrauterine contraceptive device among women attending antenatal care in a low-resource setting in Nigeria.

OBJECTIVE: To assess the level of awareness, acceptance, and any identifiable barriers to the use of postpartum intrauterine devices (PPIUDs) among pregnant women receiving care in a low-resource setting in Nigeria. METHODS: A pretested interviewer-administered questionnaire was used to obtain relevant data from all consenting pregnant women receiving antenatal care at Polyclinic and Uwani health center in the city of Enugu from January 1 to March 31, 2018. Data were entered and analyzed using Epi Info statistical software. P<0.05 was considered statistically significant. RESULTS: About two-thirds (65.6%) of the 620 respondents were unaware of PPIUDs. After counseling, about one-third (36.8%, n=228/620) of the respondents accepted having an immediate PPIUD, while the majority (63.2%, n=392/620) declined. The identified barriers towards accepting immediate PPIUDs were fear of side effects (57.9%), religious reasons (20.7%), and preference for other contraceptive methods. None of the respondents had ever inserted a PPIUD previously. CONCLUSION: The low level of acceptance of PPIUDs in the study appears to be a reflection of the low level of awareness of PPIUDs in the region. Efforts in creating awareness and health education to dispel the myths and misconceptions about PPIUDs are required in order to promote its uptake in the region.