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| ==Background==
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| *Also known as intra-amniotic infection
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| *Bacterial infection of fetal amnion and chorion membranes
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| *Most commonly an ascending infection from normal vaginal flora
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| ===Risk Factors===
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| *Young age
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| *Low socioeconomic status
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| *Multiple vaginal examinations
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| *Nulliparity
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| *Extended duration of labor and ruptured membranes
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| *Pre-existing genital tract infections
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| ===Microbiology===
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| *Polymicrobial
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| *Genital mycoplasmas, [[anaerobes]], enteric [[gram-negative]] bacilli and [[group B strep]]
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|
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| ==Clinical Features==
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| ===Signs and Symptoms===
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| *Maternal [[fever]] (intra-partum temperature >100.4 °F or >37.8 °C)
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| *Significant maternal tachycardia (>120 beats/min)
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| *Fetal tachycardia (>160-180 beats/min)
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| *Purulent or foul-smelling amniotic fluid or vaginal discharge
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| *Uterine tenderness
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| *Maternal leukocytosis (total blood leukocyte count >15,000-18,000 cell/µL)
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| ===Presentation===
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| *Severity of presentation is broad. Patient may appear toxic or may have silent chorioamnionitis, which still puts fetus at risk for neonatal sepsis.
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| ==Differential Diagnosis==
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| {{Abdominal Pain Pregnancy DDX}}
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| *Extra-amniotic infections such as [[pyelonephritis]], [[appendicitis]], [[pneumonia]]
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| ==Workup==
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| *CBC
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| *[[Blood cultures]]
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| *Vaginal fluid for phosphatidylglycerol
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| **Tests for fetal lung maturity
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| *Cervical cultures
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| **[[E. coli]]
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| **[[Gonorrhea]]
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| *Vaginal cultures
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| **[[Chlamydia]]
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| **[[Mycoplasma]]
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| **[[Group B streptococci]]
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| *[[Ultrasonography]] for fetal well-being
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| ===Exam===
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| *Avoid digital cervical exam
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| *Speculum exam should be done with sterile speculum
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| ==Management==
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| *[[Ampicillin]] IV 2g Q6H AND [[Gentamicin]] IV 1.5 mg/kg Q8H
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| *Alternative antibiotic regimens:
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| **[[Ampicillin-sulbactam]] IV 2g Q6H
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| **[[Ticarcillin-clavulanate]] IV 3.1g Q4H
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| **[[Cefoxitin]] IV 2g Q4H
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| *Can only be considered cured with delivery of infected products of conception
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| ==Disposition==
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| Given concern for neonatal sepsis, patients should be admitted for IV antibiotics, supportive care, and possible early delivery
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| ==Complications==
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| *[[Placental abruption]]
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| *Premature birth
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| *Neonatal sepsis
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| *Neonatal death
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| *Cerebral palsy
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| *Maternal [[sepsis]]
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| *Need for cesarean delivery
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| *Postpartum hemorrhage
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| ==See Also==
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| *[[Abdominal pain in pregnancy]]
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| ==External Links==
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| ==Sources==
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| *Rosen’s
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| *Tintinalli’s
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| *UpToDate
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| *Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21 (2003): 695-710.
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| *Apantaku O, Mulik V. Maternal intra-partum fever. J Obstet Gynaecol. 2007 Jan; 27(1):12-5.
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| <references/>
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