Chorioamnionitis and Severe Prematurity in Young Women: Retrospective Study at Guasmo Sur

Abstract

Objective: To assess the association between chorioamnionitis and preterm birth severity in young women at Guasmo Sur General Hospital, in Guayaquil, Guayas, Ecuador.

Methods: Retrospective cohort of 80 clinical records of spontaneous preterm birth (< 37 weeks) from 2022 involving women aged 21‑30 years. Preterm birth severity was classified as extreme, severe, moderate, or late. Prevalences were estimated and a multinomial logistic regression, adjusted for pre‑eclampsia and maternal age, was fitted (reference = late preterm birth). Post‑hoc power for OR = 2.0 and McFadden pseudo‑R² were calculated; analyses were performed with R 4.3.0 and Stata 18.

Results: Chorioamnionitis was the most frequent infection (63.8 %), followed by asymptomatic bacteriuria (23.8 %) and vaginal candidiasis (18.8 %). Moderate preterm birth accounted for 38.8 % and severe forms for 27.6 %; adolescents comprised 23 % of cases. Chorioamnionitis showed no significant association with moderate preterm birth (OR 0.47; 95 % CI 0.14‑1.60) nor with severe‑extreme preterm birth (OR 0.60; 95 % CI 0.13‑2.68); post‑hoc power was 55 % and pseudo‑R² 0.27. Pre‑eclampsia was linked to a lower risk of severe preterm birth (OR 0.03; 95 % CI < 0.01‑0.62), whereas maternal adolescence (< 21 years) markedly increased the odds of moderate (OR 15.5) and severe preterm birth (OR 129.6).

Conclusions: Although highly prevalent, chorioamnionitis did not determine preterm birth severity after adjustment, likely due to limited statistical power and clinical misclassification. Preventive efforts should prioritise early infectious screening, tight control of hypertensive disorders, and tailored prenatal care for adolescent mothers.