From the Guidelines
Fever right after delivery is not automatically considered chorioamnionitis, but it can be a sign of this condition, particularly when accompanied by other clinical signs such as uterine tenderness, fetal tachycardia, maternal tachycardia, and foul-smelling or purulent amniotic fluid. According to the guidelines from the CDC in 2010 1, chorioamnionitis is an important risk factor for early-onset group B streptococcal disease in newborns, and intrapartum fever is one sign of chorioamnionitis in parturient women. However, the diagnosis of chorioamnionitis is typically made clinically on the basis of multiple signs and symptoms, not just fever alone.
Some key points to consider in the diagnosis of chorioamnionitis include:
- Maternal fever, which might be low-grade
- Uterine tenderness
- Fetal tachycardia
- Maternal tachycardia
- Foul-smelling or purulent amniotic fluid It's also important to note that epidural labor analgesia has been associated with fever, which could lead to overdiagnosis of chorioamnionitis and unnecessary exposure to empirical antibiotics in neonates 1.
In terms of treatment, if chorioamnionitis is suspected, broad-spectrum antibiotics such as ampicillin and gentamicin, with or without clindamycin for anaerobic coverage, may be used 1. Prompt evaluation of postpartum fever is crucial, as delayed treatment of infections can lead to serious complications, including sepsis. The timing, associated symptoms, and risk factors should all be considered when evaluating fever after delivery.
From the Research
Definition of Chorioamnionitis
- Chorioamnionitis is a serious complication during labor at term, associated with adverse neonatal outcomes, and is diagnosed clinically, microbiologically, or by histopathologic examination of the placenta and umbilical cord 2.
- 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 2, 3.
Diagnosis of Chorioamnionitis
- The diagnosis of clinical chorioamnionitis is based on a combination of signs, including fever, maternal or fetal tachycardia, foul-smelling amniotic fluid, uterine tenderness, and maternal leukocytosis 3.
- However, the accuracy of each clinical sign for the identification of microbial-associated intra-amniotic inflammation ranges between 46.7% and 57.8% 3.
- The combination of fever with three or more clinical criteria does not substantially improve diagnostic accuracy 3.
Fever after Delivery and Chorioamnionitis
- Maternal fever during labor is associated with chorioamnionitis and neonatal sepsis if at least two of the following five criteria are also present: maternal tachycardia, purulent or foul-smelling amniotic fluid, fetal tachycardia, uterine tenderness, or maternal leukocytosis 4.
- However, fever right after delivery is not necessarily considered chorioamnionitis, as the condition is often associated with other symptoms such as uterine tenderness, maternal tachycardia, and leukocytosis 2, 3, 4.
- Recent studies suggest that clinical chorioamnionitis is a heterogeneous syndrome, and the presence of fever alone may not be sufficient to diagnose chorioamnionitis 5.
Predictive Value of Clinical Symptoms
- The positive predictive value for histological funisitis in cases of maternal fever of 38 degrees or higher is only 15.5% 6.
- However, in cases of maternal fever with uterine fundal tenderness and purulent or foul amniotic fluid or cervical discharge at term, the positive predictive value for histological chorioamnionitis is 100% 6.