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Increased Rates of Chorioamnionitis With Extra-Amniotic Saline Infusion Method of Labor Induction

Kenneth A. Levey, MD, MPH^*, Andrew P. MacKenzie, MD^*, Courtney Stephenson, DO^*, Richard Bercik, MD^*, Edward Kuczynski, PhD and Edmund F. Funai, MD

From the *Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York; and Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut.

Address reprint requests to: Kenneth A. Levey, MD, MPH, NYU School of Medicine, Department of Obstetrics and Gynecology, 550 First Avenue, Suite 9E2, New York, NY 10016; e-mail: leveyk01{at}med.nyu.edu.

OBJECTIVE: Extra-amniotic saline infusion has been shown to be equal to or more efficacious than misoprostol, laminaria, dinoprostone, and prostaglandin estradiol for cervical ripening and labor induction. Because of the introduction of a foreign body into the uterus, extra-amniotic saline infusion may potentially cause increased rates of chorioamnionitis. This study examines the risk of chorioamnionitis with extra-amniotic saline infusion compared with other methods of induction and spontaneous labor.

METHODS: A retrospective analysis was performed based on deliveries at Bellevue Hospital Center, a tertiary-care facility, from August 2000 to December 2002. Three groups were identified: extra-amniotic saline infusion, other methods of induction, and spontaneous labor. Differences in chorioamnionitis rates were analyzed by using analysis of variance and multivariable logistic regression as appropriate.

RESULTS: There were 625 charts evaluated: 171 extra-amniotic saline infusion, 190 other, and 264 with spontaneous labor. The rates of chorioamnionitis were 26.9%, 17.9%, and 13.3%, respectively. After adjusting for confounding variables, such as instrumentation, length of rupture, and number of exams, subjects who were induced with extra-amniotic saline infusion were significantly more likely to develop chorioamnionitis (relative risk = 2.2; 95% confidence interval 1.4, 4.0; P = .006).

CONCLUSION: Extra-amniotic saline infusion may be associated with a greater risk of chorioamnionitis when compared with other methods of labor induction. Given the increased risk of chorioamnionitis associated with extra-amniotic saline infusion, its use should be in the context of a careful assessment of the risks and benefits of various methods of labor induction.

LEVEL OF EVIDENCE: II-2

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