From the Guidelines
Chorioamnionitis is defined as an intraamniotic infection, which is typically documented by a physician and prompts treatment with antibiotics, and is characterized by symptoms such as fever, uterine tenderness, fetal tachycardia, and foul-smelling amniotic fluid. According to the most recent study 1, maternal morbidity, which includes chorioamnionitis, is a common outcome after expectant management of preterm prelabor rupture of membranes (PPROM) at less than 24 weeks of gestation. The study found that 60% of women with PPROM at less than 24 weeks of gestation developed maternal morbidity, which includes chorioamnionitis.
Key Characteristics of Chorioamnionitis
- Intraamniotic infection
- Documented by a physician
- Prompts treatment with antibiotics
- Symptoms include:
- Fever
- Uterine tenderness
- Fetal tachycardia
- Foul-smelling amniotic fluid
Risk Factors for Chorioamnionitis
- Prolonged labor
- Multiple vaginal exams during labor
- Premature rupture of membranes
- Certain sexually transmitted infections
Treatment of Chorioamnionitis
- Broad-spectrum antibiotics such as ampicillin (2g IV every 6 hours) plus gentamicin (1.5mg/kg IV every 8 hours)
- Treatment should continue until at least 24-48 hours after delivery
The diagnosis of chorioamnionitis is typically made clinically, based on signs and symptoms such as fever, uterine tenderness, fetal tachycardia, and foul-smelling amniotic fluid 1. It is essential to note that chorioamnionitis can lead to serious complications for both mother and baby if left untreated, making early diagnosis and treatment crucial for preventing these adverse outcomes.
From the Research
Definition of Chorioamnionitis
- Chorioamnionitis is defined as the inflammatory response to an acute inflammation of the membranes and chorion of the placenta 2.
- It is also described as an acute inflammation of the chorion, with or without involvement of the amnion, and is evidence of a maternal immunological response to infection 3.
- Chorioamnionitis can exist in histologic, clinical, and subclinical forms 4.
Diagnosis of Chorioamnionitis
- The clinical criteria for chorioamnionitis include maternal fever combined with 2 or more findings of maternal tachycardia, fetal tachycardia, leukocytosis, uterine tenderness, and/or malodorous amniotic fluid 5.
- Chorioamnionitis can be diagnosed clinically, microbiologically, or by histopathologic examination of the placenta and umbilical cord 5.
- Antenatal diagnosis of chorioamnionitis is limited, but fetal and placental imaging, such as ultrasound and MRI, may provide valuable information regarding the diagnosis of fetal inflammatory response 3.
Implications of Chorioamnionitis
- Chorioamnionitis is associated with adverse maternal, perinatal, and long-term outcomes, including preterm birth, neonatal sepsis, pneumonia, bronchopulmonary dysplasia, perinatal death, cerebral palsy, and intraventricular hemorrhage 2.
- Maternal complications include abnormal progression of labour, caesarean section, postpartum hemorrhage, abnormal response after use of oxytocin, and placenta abruption 2.
- Prompt administration of antibiotics and steroids may improve neonatal outcomes 2.