From the Guidelines
Chorioamnionitis is not an absolute exclusion criterion for vacuum-assisted delivery, but it should be considered a relative contraindication that requires careful evaluation of the benefits and risks. When managing a delivery complicated by chorioamnionitis, the decision to use vacuum assistance should be made carefully, weighing the benefits of expediting delivery against potential risks, as prompt delivery is often desirable to reduce fetal exposure to infection 1. In cases of chorioamnionitis, vacuum assistance may help achieve the goal of prompt delivery when indicated for other obstetric reasons such as prolonged second stage or maternal exhaustion. However, caution is warranted as the infected amniotic environment may theoretically increase the risk of scalp infections at the vacuum application site. The decision should be individualized based on the clinical situation, including the severity of infection, fetal status, stage of labor, and available alternatives, and should consider the latest guidelines for the prevention of perinatal group B streptococcal disease 1. Other standard contraindications for vacuum delivery still apply, such as prematurity (less than 34 weeks), fetal coagulation disorders, or abnormal fetal presentation. If vacuum assistance is used in the setting of chorioamnionitis, close neonatal follow-up is essential to monitor for signs of infection at the application site or other complications. Some key considerations in the management of chorioamnionitis include:
- The presence of maternal risk factors for GBS neonatal disease
- The likely efficacy of intrapartum antibiotics in preventing early-onset disease
- The importance of empirical antimicrobial therapy for newborn infants with signs of sepsis
- The need for a limited diagnostic evaluation for well-appearing newborn infants born to women with a diagnosis of chorioamnionitis. It is crucial to weigh these factors carefully and make an informed decision based on the most recent and highest-quality evidence available 1.
From the Research
Chorioamnionitis and Vacuum Assisted Delivery
- There is no direct evidence in the provided studies that chorioamnionitis is an exclusion criteria for vacuum assisted delivery 2, 3, 4, 5, 6.
- The studies focus on the management and treatment of chorioamnionitis, as well as its association with adverse maternal outcomes by mode of delivery 2, 3, 4, 5, 6.
- One study suggests that vaginal delivery is the safer option and cesarean delivery should be reserved for standard obstetrical indications 2.
- Another study found that chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery, but was associated with increased odds of adverse maternal outcomes with cesarean delivery 6.
- However, none of the studies specifically address the use of vacuum assisted delivery in the context of chorioamnionitis, making it unclear whether it is an exclusion criteria or not 2, 3, 4, 5, 6.
Key Findings
- Chorioamnionitis is a significant cause of maternal and neonatal morbidity 2, 3, 4, 5, 6.
- The mainstay of treatment includes antimicrobial agents, antipyretics, expedition of delivery, and supportive care 2, 4.
- Prompt diagnosis and timely treatment with broad-spectrum antibiotics can help avert significant short-term and long-term consequences 5.