Duration of Antibiotic Treatment for Chorioamnionitis After Delivery
For women with chorioamnionitis who deliver vaginally, a single additional dose of antibiotics postpartum is sufficient therapy, while those who deliver via cesarean may require continuation of antibiotics until afebrile and asymptomatic for 24 hours. 1
Treatment Regimens Based on Delivery Method
Vaginal Delivery
- Intrapartum antibiotics should be initiated as soon as chorioamnionitis is diagnosed, typically with ampicillin and gentamicin 2, 3
- After vaginal delivery, only the next scheduled dose of each antibiotic is required to complete treatment 1
- Success rates with this limited course approach are extremely high (99%) for vaginal deliveries 4
Cesarean Delivery
- Women who undergo cesarean delivery should receive clindamycin at the time of umbilical cord clamping in addition to the ampicillin and gentamicin regimen 2, 1
- After cesarean delivery, antibiotics should be continued until the patient is afebrile and asymptomatic for 24 hours 1
- The treatment failure rate is higher after cesarean delivery (15%) compared to vaginal delivery (1%) 4
Antibiotic Selection
- First-line antimicrobial regimen for chorioamnionitis is ampicillin combined with gentamicin 2, 3
- For cesarean delivery, add clindamycin at cord clamping to provide anaerobic coverage 2, 1
- Recent evidence supports daily dosing of gentamicin rather than three-times-daily dosing for greater efficacy and decreased fetal toxicity 3
Monitoring for Treatment Success
- Treatment failure is defined as persistent fever requiring continuation of antibiotics, need for surgical intervention, or administration of heparin 4
- Signs of treatment failure include a single temperature ≥39.0°C or two temperatures ≥38.4°C at least 4 hours apart after the first postpartum dose of antibiotics 1
- Most treatment failures after cesarean delivery present as endometritis and respond to continued antibiotic therapy 4
Special Considerations
- Patients with risk factors such as obesity, prolonged labor, or prolonged rupture of membranes who deliver by cesarean may benefit from extended antibiotic therapy 4
- More serious complications like wound infections or septic thrombophlebitis occur almost exclusively after cesarean deliveries 4
- Intrapartum antibiotic administration is superior to postpartum initiation in reducing maternal and neonatal hospital stay duration 5
Neonatal Management
- Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation and receive antibiotic therapy pending culture results 6
- The evaluation should include a blood culture and a CBC including white blood cell differential and platelet count 6
- Consultation with obstetric providers to assess whether chorioamnionitis was suspected is important to determine appropriate neonatal management 6