Chorioamnionitis

Background

  • Also known as intra-amniotic infection[1]
  • Bacterial infection of fetal amnion and chorion membranes
  • Most commonly an ascending infection from normal vaginal flora

Risk Factors

  • Young age
  • Low socioeconomic status
  • Multiple vaginal examinations
  • Nulliparity
  • Extended duration of labor and ruptured membranes
  • Pre-existing genital tract infections

Microbiology

Clinical Features

Signs and Symptoms

  • Maternal fever (intra-partum temperature 102.2°F (≥39.0°C) once, OR two temperatures between >100.4°F - 102.2°F measured 30 min apart) with no other clear infectious source [2] PLUS
  • One or more of the following
    • Fetal tachycardia (>160-180 beats/min)
    • Purulent or foul-smelling amniotic fluid or vaginal discharge
    • Maternal leukocytosis (total blood leukocyte count >15,000/mm3)
  • Maternal tachycardia and uterine tenderness, suggestive but not specific.

Presentation

  • Severity of presentation is broad. Patient may appear toxic or may have silent chorioamnionitis, which still puts fetus at risk for neonatal sepsis.

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time

Workup

Exam

  • Avoid digital cervical exam
  • Speculum exam should be done with sterile speculum

Management

Disposition

Given concern for neonatal sepsis, patients should be admitted for IV antibiotics, supportive care, and possible early delivery[5]

Complications

See Also

External Links

References

  1. Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21 (2003): 695-710.
  2. Higgins RD, Saade G, Polin RA, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a workshop. Obstet Gynecol 2016; 127:426
  3. Snyder M. et al. Clinical inquiries. What treatment approach to intrapartum maternal fever has the best fetal outcomes?. J Fam Pract. May 2007;56(5):401-2
  4. Lyell DJ, Pullen K, Fuh K, Zamah AM, Caughey AB, Benitz W, El-Sayed YY. Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):344-9
  5. Driscoll SG. Chorioamnionitis: perinatal morbidity and mortality. Pediatr Infect Dis. 1986;5