From the Guidelines
Internal fetal monitoring is generally contraindicated for laboring patients with active chlamydia infection. The placement of internal monitors (such as fetal scalp electrodes or intrauterine pressure catheters) should be avoided in these patients because the procedure can potentially transmit the infection from the mother's genital tract to the fetus during labor. Chlamydia trachomatis is an ascending infection, and invasive procedures that breach the protective barrier between the vaginal canal and the uterine cavity or fetus can increase the risk of vertical transmission, potentially leading to neonatal conjunctivitis, pneumonia, or other complications.
Key Considerations
- External monitoring methods, such as external tocodynamometry for contractions and external Doppler ultrasound for fetal heart rate, should be used instead 1.
- If the patient has been adequately treated for chlamydia (typically with azithromycin 1g orally as a single dose or doxycycline 100mg orally twice daily for 7 days) and completed therapy at least 7 days before labor, internal monitoring may be considered if clinically necessary.
- In cases where internal monitoring is deemed absolutely necessary despite active infection, the risks and benefits should be carefully weighed, and prophylactic antibiotics for the neonate should be considered.
- The Society for Maternal-Fetal Medicine suggests that obstetrical care providers screen HCV-positive pregnant patients for other sexually transmitted infections (if not done previously), including HIV, syphilis, gonorrhea, chlamydia, and HBV 1.
Management of Labor
- Avoid internal fetal monitors and early artificial rupture of membranes when managing labor in patients with HCV unless necessary in the course of management 1.
- Consider the risks and benefits of internal monitoring in patients with active chlamydia infection, and weigh the potential benefits against the potential risks of vertical transmission.
- Use external monitoring methods whenever possible to minimize the risk of transmission.
From the Research
Internal Monitors in Laboring Patients with Chlamydia
- There is no direct evidence to suggest that internal monitors are contraindicated for laboring patients with chlamydia 2, 3, 4, 5, 6.
- However, the use of internal monitors, such as fetal scalp electrodes and intrauterine pressure catheters, has been associated with an increased risk of maternal fever and cesarean delivery 4.
- Chlamydia infection during pregnancy can lead to pregnancy complications such as miscarriage, preterm labor, low birthweight, and preterm rupture of membranes 3.
- Treatment of chlamydia infection during pregnancy with antibiotics such as azithromycin, erythromycin, and amoxicillin has been shown to be effective in achieving microbiological cure and reducing the risk of pregnancy complications 3, 5, 6.
- The choice of antibiotic treatment for chlamydia infection during pregnancy should be based on the severity of the infection, the presence of any underlying medical conditions, and the potential risks and benefits of each treatment option 3, 5, 6.
Considerations for Internal Monitors in Laboring Patients with Chlamydia
- The decision to use internal monitors in laboring patients with chlamydia should be made on a case-by-case basis, taking into account the individual patient's medical history, the severity of the chlamydia infection, and the potential risks and benefits of internal monitoring 4.
- Healthcare providers should carefully weigh the potential benefits of internal monitoring, such as improved fetal monitoring and reduced risk of fetal distress, against the potential risks, such as increased risk of maternal fever and cesarean delivery 4.
- Patients with chlamydia infection during pregnancy should be closely monitored for signs of pregnancy complications and treated promptly with antibiotics if necessary 3, 5, 6.