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 >100.4 °F or >37.8 °C)[2]
  • Significant maternal tachycardia (>120 beats/min)
  • Fetal tachycardia (>160-180 beats/min)
  • Purulent or foul-smelling amniotic fluid or vaginal discharge
  • Uterine tenderness
  • Maternal leukocytosis (total blood leukocyte count >15,000-18,000 cell/µL)

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 pathologies 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[4]

Complications

  • Placental abruption
  • Premature birth
  • Neonatal sepsis
  • Neonatal death
  • Cerebral palsy
  • Maternal sepsis
  • Need for cesarean delivery
  • Postpartum hemorrhage

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. Apantaku O, Mulik V. Maternal intra-partum fever. J Obstet Gynaecol. 2007 Jan; 27(1):12-5.
  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. Driscoll SG. Chorioamnionitis: perinatal morbidity and mortality. Pediatr Infect Dis. 1986;5