Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes.

OBJECTIVE: To determine whether ripening and induction in patients with term premature rupture of membranes (PROM) via intracervical balloon placement (ICB) increases the risk of chorioamnionitis when compared to women with term PROM ripened and induced with other methods.

STUDY DESIGN: A retrospective cohort study of term singleton gestations undergoing ripening and induction after PROM between July 2009 and June 2012 was conducted. Exposure of interest was ICB placement. Primary outcome of interest was chorioamnionitis. Statistical analysis included bivariate and multivariate techniques.

RESULTS: Of 124 term PROM patients, 42 were ripened by ICB with or without oxytocin (33.9%) and 82 were ripened and induced with oxytocin (66.1%). More women ripened with an ICB were nulliparous (n = 35, 83.3% ICB versus n = 44, 53.7% oxytocin, p = 0.001). Chorioamnionitis was slightly more common in women ripened with ICB and/or oxytocin versus oxytocin alone but difference did not reach statistical significance (p = 0.10). The rate of cesarean delivery, intrauterine pressure catheter (IUPC) use, and median lengths of membrane rupture and active labor were higher in the ICB group. After adjustment, chorioamnionitis was not correlated with ICB placement but with nulliparity [AOR 12.5 (1.36, 114.6), p = 0.03] and IUPC use [AOR 4.39 (1.04, 18.5), p = 0.04].

CONCLUSION: Nulliparity and IUPC, not ICB placement, were associated with chorioamnionitis.