Premium
Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study
Author(s) -
Spénard Elisabeth,
Tordjman Laurent,
MarriéMas AnnElisabeth,
Dal Soglio Dorothee,
Eberle Alexa,
Labbé AnnieClaude,
Boucoiran Isabelle
Publication year - 2023
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.14488
Subject(s) - medicine , chorioamnionitis , psychological intervention , obstetrics , incidence (geometry) , pregnancy , neonatal infection , pediatrics , gestation , genetics , physics , psychiatry , optics , biology
Objective To assess the impact of a quality‐improvement initiative designed to increase diagnostic accuracy and adequate management of clinical chorioamnionitis (CC) at a tertiary center. Chorioamnionitis occurs in 1%–13% of term pregnancies and increases maternal and neonatal peripartum complications; often over‐diagnosed, it leads to unnecessary investigations and treatments. Methods This was an interrupted time‐series study. In September 2017 two interventions were implemented: (1) staff training and (2) standardized clinical protocol for the management of fever in labor. All singleton term pregnancies were included. CC cases were reviewed in the pre‐intervention (2015–2016, n = 179) and post‐intervention (2017–2018, n = 142) groups. CC criteria based on the American College of Obstetricians and Gynecologists guidelines, antibiotics, maternal and neonatal outcomes, and pathology were compared. A cost–consequence analysis was performed. Results Incidence of CC decreased from 8.2 to 5.6 per 10 person‐year ( P < 0.001). This was associated with a significant increase in diagnostic accuracy from 15.7% to 73.2% ( P < 0.001). Weight‐adjusted tobramycin dosage improved from 8.8% to 69.1% ( P < 0.001). Maternal length of hospitalization and readmissions decreased significantly, without affecting neonatal sepsis rate. Interventions decreased yearly hospital costs associated with CC by 23.4%. Conclusion Standardizing the management of fever in labor significantly increased the diagnostic accuracy of CC and decreased the misuse of antibiotics in term pregnancies. CC costs decreased by 23.4%.