(396) Infectious Outcomes following Incidental AROM with Intracervical Foley Placement

Incidental amniotomy following intracervical ripening is well described; however, its impact on the likelihood of maternal or neonatal infections has not been well defined.

Study Design:

This is a retrospective cohort study of all pregnancies at a single institution admitted for a term ( >37 weeks) induction of labor with a Foley bulb between January 1^st, 2012, and December 31^st, 2021. They were divided into two groups: those who had incidental rupture of membranes (ROM) recorded within 60 minutes of Foley bulb placement, and those who did not. Patients whose membranes ruptured prior to Foley bulb placement were excluded.  Our primary outcome was the occurrence of clinical chorioamnionitis. The two groups were compared using univariate statistics.

Results:

A total of 8112 women met study criteria, of which 427 (5.26%) women experienced ROM with Foley bulb placement. Demographics including maternal race, gravidity, parity, BMI, or gestational age at time of induction did not differ between the two groups. Maternal age was slightly lower in the early ROM group (28.3 versus 29.0, p = 0.03). ROM with Foley bulb was associated with an increased likelihood of chorioamnionitis (12.41% versus 7.20%, p=0.00), but not with increased antibiotic administration. The rate of endometritis, maternal pneumonia, and UTI were similar between the groups. Neonatal outcomes including death, hypoglycemia, sepsis, or respiratory assistance within 72 hours of delivery did not differ between groups.  There was an increased risk of 1-minute APGAR less than 4 (3.28% versus 1.59%, p=0.01) as well as admission to the NICU in the early ROM group (27.87% versus 21.42%, p = 0.002). There was no statistically significant difference in 5-minute APGARs.

Conclusion:

Rupture of membranes with a Foley bulb was associated with an increased risk of chorioamnionitis, lower 1-minute APGARs, and a higher likelihood of NICU admission. Further study of prophylactic antibiotics could be considered to mitigate these risks.