Chorioamnionitis, also known as intra-amniotic infection, is a critical obstetric condition characterised by inflammation of fetal membranes secondary to bacterial infection [1, 2]. Preterm birth, neonatal infection, and long-term developmental problems seriously compromise maternal and fetal health [3, 4]. Antibiotics are the cornerstone of clinical care for suspected chorioamnionitis as they target the mother’s infection and halt its development to the fetus, thereby reducing the risks [1, 5]. Optimising treatment strategies depends on the awareness of the pharmacokinetics of the mother-fetal antibiotic dispersion, thereby guaranteeing therapeutic efficacy while reducing possible damage [6, 7, 8]. Although these treatments are essential, our knowledge of how antibiotics pass through the placental barrier and their consequent impact on fetal health still lags [1]. Driven by developments in pharmacology and obstetric medicine, research in this field has expanded over the years; however, complete knowledge remains elusive.

Recently, significant advancements in the fields of embryology and prenatal medicine were observed regarding the identification of specific antibiotic agents targeting microorganisms associated with chorioamnionitis [1, 3]. Notable improvements in maternal and infant care across various clinical settings have also stemmed from these advancements [9, 10]. However, these recommendations require further systematic investigation, especially considering the complexities arising from maternal immune responses and the pharmacokinetics of antibiotics [10]. Attaining fetal therapeutic levels of such antibiotics involves various influential factors, including drug characteristics, gestational age, and placental capacity, all of which require meticulous examination [11]. As global attention to maternal and neonatal health continues to grow [12], bibliometric studies [13, 14] offer a valuable framework for tracking scientific advances, collaboration networks, and identifying existing knowledge gaps in this research field.

Despite the growing body of literature on maternal-fetal antibiotic dynamics in suspected chorioamnionitis (MFADESC) [1, 15], existing research remains limited and lacks a cohesive framework to guide clinical practice. Critical questions persist regarding the optimal antibiotic regimens for different clinical contexts, their long-term effects on fetal development, and their roles in emerging antibiotic resistance. This bibliometric analysis addressed these gaps by mapping the global research landscape and identifying publication trends, influential contributors, and emerging themes. By leveraging advanced bibliometric tools, such as citation network analysis, co-authorship mapping, and thematic evolution tracking [16, 17], this study determined key trends, influential contributors, thematic evolution, and research gaps in MFADESC. It underscored high-impact research for integration into infection management protocols, revealed shifts in antibiotic strategies, and emphasised the need for enhanced diagnostic approaches. The findings provide a structured foundation for clinical innovations, fostering interdisciplinary collaboration to bridge research and practice. The study addresses the following: What are the key trends, thematic evolutions, influential contributors, and research gaps in MFADESC research as revealed through bibliometric analysis?

Given the importance of MFADESC research and the sizeable number and diversity of studies in numerous fields, it is essential to continually and routinely re-evaluate this area of research. Therefore, this study conducted a comprehensive bibliometric analysis of MFADESC research from 1963 to 2024. This study conducted a performance analysis and evaluated factors such as publication output, citation impact, collaboration patterns, and author productivity. Moreover, this study intends to create a conceptual map of research in MFADESC, identifying key research themes, influential authors, and the interconnections between different areas of study. The analysis also revealed emerging trends in MFADESC research, highlighting evolving research interests, novel research directions, and potential future developments in this field.

This study encompasses all empirical studies published in English. Through the analytical capacity of primary research in original studies, we acquire insights into innovative methodologies, theoretical frameworks, and pioneering discoveries that influence the direction of the field. We emphasise the necessity of using multilingual viewpoints to accurately capture regional subtleties and enhance the understanding of MFADESC research, while recognising the prevalence of English-language data. This research is consistent with prior studies that have employed an original analysis grounded in English [24, 31, 32].

Over the years, MFADESC research has grown remarkably, with 53.8% of the research papers published between 2015 and 2024. This increase in MFADESC research can be attributed to several factors. A greater understanding of mother-fetal health issues has encouraged research on the diagnosis and treatment of conditions such as chorioamnionitis, which are detrimental to mothers and newborns [33]. Advancements in diagnostic systems have allowed researchers to elucidate unexplored aspects of intra-amniotic infections and aspects of antibiotic treatment [34]. Furthermore, the rising incidence of premature births and other related complications requires more in-depth research [4]. A large number of specific research projects were created as a result of joint international initiatives, such as the Sustainable Development Goals, which focus on the reduction of maternal and neonatal mortality [35]. Studies combining knowledge from microbiology, obstetrics, and pharmacology have been made possible by enlarging cooperative networks and financing possibilities.

The USA leads the world in MFADESC research, illustrated by its dominance, with 696 publications and 13,704 overall citations. A notable emphasis on multidisciplinary studies that integrate microbiology, obstetrics, and pharmacology, including a great healthcare system and agency sponsorship, accounts for this significance [36]. The US has created many new programs, such as the “Triple I” framework, to enhance the quality and quantity of the healthcare system’s research [10]. Moreover, they are active participants in relevant international initiatives that significantly broaden the scope of the innovations they create. Altogether, NIH initiatives exhibit strong performance, proving the US’s leadership role in mother-fetal healthcare and advancing the field worldwide. This correlates with prior bibliometric analyses revealing the role of the USA in maternal health interventions [37, 38].

Romero, R., Chief of the Pregnancy/Perinatology Research Branch at the National Institutes of Health, USA, is the most prolific and influential contributor in MFADESC research, playing a pivotal role in advancing the understanding and management of chorioamnionitis and its associated conditions. The patient had an h-index of 28. His work explored the presence of antimicrobial peptides in amniotic fluid as markers of microbial invasion and inflammation, shedding light on their role in preterm labour and membrane rupture [20]. He has contributed to research highlighting the limitations of antibiotic therapy in eliminating intra-amniotic infections among patients with preterm premature rupture of membranes [6]. Romero also explored the diagnostic significance of a sonographically short cervix as a feature of intra-amniotic infection [28] and further developed the notion of the fetal inflammatory response syndrome, explaining its pathophysiological mechanisms responsible for the syndrome and its clinical presentation [39]. His study on the effect of antibiotic administration in certain groups of patients with cervical incompetence and intra-amniotic infection has highlighted important aspects regarding individualised treatment [40]. Moreover, Romero’s works have also highlighted the inflammatory factors responsible for preterm and term labour [41] and conducted randomised trials testing whether antibiotic treatment would reduce preterm labour with intact membranes [9]. All of these endeavours demonstrate, in unison, the decisive contribution that Dr. Romero has made in facilitating research and clinical practice in the area of maternal-fetal medicine.

Higgins et al. [10], the most frequently cited article in MFADESC research, compiled results from a January 2015 workshop called by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This session encompassed knowledge gaps and offered evidence-based recommendations for identifying and treating chorioamnionitis-affected pregnant women and their neonates. The panel underlined the variation in clinical practice resulting from the different use of the word “chorioamnionitis”, which describes disorders marked by infection, inflammation, or both. To standardise terminology, the panel proposed replacing “chorioamnionitis” with the broader term “intrauterine inflammation or infection or both” (Triple I). A classification system for Triple I was introduced along with the recommended evaluation and management approaches. Importantly, this study emphasised that isolated maternal fever is not synonymous with chorioamnionitis. A research agenda was also proposed to refine the definitions and management strategies for this complex condition [10].

The thematic evolution of MFADESC research reflects significant advancements and adaptability of the field to satisfy evolving clinical challenges and research priorities. The initial focus on foundational themes like “chorioamnionitis”, “premature birth”, and “group B streptococcus” from 1963 to 2010 highlights early efforts to understand the microbial and inflammatory underpinnings of maternal-fetal infections [3, 9]. These foundational studies laid the groundwork for more specialised and targeted research in the subsequent decades. Between 2011 and 2020, advancements in diagnostic techniques and therapeutic approaches are evident in the emergence of themes such as “antibiotics”, “Escherichia coli”, and “preterm infants”. This reflects a shift toward addressing the complexities of maternal and neonatal infections and improving treatment outcomes [6, 26]. The decline of certain topics, such as “gentamicin” and “septicemia”, during this period indicates the field’s move toward more refined and effective strategies, reflecting the natural progression of research as some approaches are replaced or optimised. The 2021–2024 period marks a further evolution, underscoring on clinical applications and unmet needs. Emerging themes like “antibiotic efficacy”, “maternal chorioamnionitis”, and “neonatal intensive care unit” highlight the increasing emphasis on optimising therapeutic strategies and addressing specific challenges in maternal and neonatal care [1, 42]. Furthermore, the branching into applicable settings like “amnioinfusion” and “nosocomial infections” emphasises the pragmatic relevance of MFADESC research in addressing perinatal management problems. Driven by multidisciplinary partnerships and technological developments, this progression demonstrates the dynamic nature of MFADESC research. The field’s commitment to improving maternal and neonatal health is reflected in the continuous evolution and refinement of its core themes. These findings highlight the importance of addressing knowledge gaps, fostering innovation, and ensuring the translation of research discoveries into meaningful clinical practices [10, 41]. As the field progresses, these thematic shifts reflect their ability to adapt and remain relevant in tackling contemporary challenges in maternal-fetal health.

This work acknowledges the constraints of using Scopus as a single database for this research. To overcome these limitations and offer a more complete analysis, this study employed a range of datasets and sources. This study offers significantly new perspectives on the conceptual history of the discipline, even though studies conducted in languages other than English were excluded. There were a few methodological issues when using applications such as Bibliometrix and VOSviewer. It is important to be aware of the numerous disadvantages of these tools, including the learning curve, the necessity of data pretreatment, the interpretation and parameter selection process, scalability problems, and the inherent limits of the tools. Moreover, the underrepresentation of new individuals and self-citation bias could affect the outcomes. Excluding self-citations and other strategies can help decrease these limits. A fair understanding of the conclusions and an accurate interpretation of the results rely on realising these prejudices and restrictions.

Data from this study reflect the gradual progression of MFADESC research. Emphasising its part in promoting this field, the US leads in citations and production. Along with newly developing patterns in maternal morbidity and treatment approaches, topical evolution has highlighted important study issues, including chorioamnionitis, antibiotic efficacy, preterm birth, infant outcomes, and global diagnostic strategies. However, major research gaps remain, especially in underrepresented areas, particularly in optimising antibiotic regimens, creating uniform diagnostic techniques, and enhancing world cooperation. This study indicates creating and using cutting-edge diagnostics tools, including biomarker-based screening techniques for intra-amniotic infections, supporting clinical trials to evaluate antibiotic efficacy and long-term fetal effects, and encouraging multidisciplinary and worldwide cooperation to enhance knowledge-based practices and evidence-based practices by means of these tools. Strengthening these areas will help to influence the next clinical recommendations and lead to better mother-fetal health results.

• MFADESC research has steadily increased, with 1606 original articles and an 8.16% annual growth rate, underscoring key themes such as chorioamnionitis, antibiotic efficacy, neonatal outcomes, and maternal morbidity.

• The study identified 40 prolific scholars, with Kacerovsky, M. and Romero, R. leading in collaboration, indicating strong interdisciplinary and international research networks.

• The USA is at the forefront in research productivity and total citations, with significant contributions from the UK, Japan, Canada, Europe, and Asia.

• Despite these advancements, research gaps remain in optimising antibiotic regimens, improving diagnostics, and addressing regional disparities in research collaborations.

• Bibliometric analysis using VOSviewer and Bibliometrix provided insights into research trends, thematic evolution, citation impact, and underexplored areas.

• Enhancing diagnostic techniques, fostering interdisciplinary collaboration, and prioritising neonatal care and maternal infection management are essential for advancing maternal-fetal health outcomes.

All data included in this study are available from the corresponding author upon reasonable request.

AHK was the sole author and was responsible for the design of the work, drafting and revision of content, and approval of the version to be published. AHK has participated sufficiently in the work and agreed to be accountable for all aspects of the work.

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This research received no external funding.

The author declares no conflict of interest.

Supplementary material associated with this article can be found, in the online version, at https://doi.org/10.31083/BJHM53141.