Chorioamnionitis

Last updated 20.05.13

 

Definition

- Infection of amniotic fluid, membranes, placenta &/or uterine deciduas during pregnancy

 

Features

- Associated with 20-40% of causes of early neonatal sepsis & pneumonia

- Highest incidence in preterm deliveries

- Associated with 1/3 cases of preterm labour with intact membranes

- Effects 40% women with PPROM & contractions

- Effects 2-4% term deliveries

 

Causes

- Polymicrobial

- Primarily ascending infection

- Ureaplasma & Mycoplasma most common

- +/- anaerobes (Gardnella vaginalis)

- +/- GBS

- +/- enteric gram negative bacilli

 

Risk Factors

- Primparous

- Spontaneous labour

- Prolonged ROM

- MSL

- Multiple VE (esp if ROM)

- FSE

- GBS positive

- BV

- Prolonged labour

 

Associated S/S

- Fever >38oc

- Tachycardia

-  Maternal >100

-  Fetal >160

- Uterine tenderness

- Foul odour of amniotic fluid

- +/- furnisitis

 

DDx

- Labour: nil fever unless Epidural

- Abruption: vaginal bleeding

- Other infections

 

Complications

- Bacteraemia 5-10%

- Sepsis

- Coagulopathy

- Adult RDS

- PPH

- Uterine atony

- LUSCS

- Neonatal

-  Meningitis

-  Pneumonia

-  Sepsis

 

Ix

- +/- Amniocentesis for MCS

- FBE

- CRP

- +/- B/C

 

Mx

- Rx for presumed chorioamniontis even in context of possible epidural induced fever

- Antibiotics: broad spectrum

-  Ampicillin 2g IV 6/24

-  Plus Gentamicin 4-6mg/kg single dose (daily up to 2 doses)

-  Plus Metronidazole 500mg IV 12/24

-  Continue for 1 dose post partum

 

 

 

References

 

Upto Date: Intra-amniontic Infection (Chorioamnionitis), 17/02/2012