Maternal and Perinatal Outcomes following Trial of Labor after Cesarean in Women with previous Term Cesarean Delivery and Chorioamnionitis

Objective This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery. Study Design This multicenter retrospective cohort study (2005-2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes. Results Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, p = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, p < 0.001), and postpartum readmission (2.3 vs. 0.5%, p = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, p = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, p = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13-1.99, p = 0.005). Conclusion Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population. Key Points Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis. Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery. Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture.