Chorioamnionitis: Difference between revisions

No edit summary
(14 intermediate revisions by 7 users not shown)
Line 1: Line 1:
==Background==
==Background==
*Also known as intra-amniotic infection
*Also known as intra-amniotic infection<ref>Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21 (2003): 695-710.</ref>
*Bacterial infection of fetal amnion and chorion membranes
*Bacterial infection of fetal amnion and chorion membranes
*Most commonly an ascending infection from normal vaginal flora
*Most commonly an ascending infection from normal vaginal flora
Line 18: Line 18:
==Clinical Features==
==Clinical Features==
===Signs and Symptoms===
===Signs and Symptoms===
*Maternal [[fever]] (intra-partum temperature >100.4 °F or >37.8 °C)
*Maternal [[fever]] (intra-partum temperature 102.2°F (≥39.0°C) once, OR two temperatures between >100.4°F - 102.2°F measured 30 min apart) with no other clear infectious source <ref>Higgins RD, Saade G, Polin RA, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a workshop. Obstet Gynecol 2016; 127:426</ref> PLUS
*Significant maternal tachycardia (>120 beats/min)
*One or more of the following
*Fetal tachycardia (>160-180 beats/min)
**Fetal tachycardia (>160-180 beats/min)
*Purulent or foul-smelling amniotic fluid or vaginal discharge
**Purulent or foul-smelling amniotic fluid or [[vaginal discharge]]
*Uterine tenderness
**Maternal [[leukocytosis]] (total blood leukocyte count >15,000/mm3)
*Maternal leukocytosis (total blood leukocyte count >15,000-18,000 cell/µL)
 
*Maternal tachycardia and uterine tenderness, suggestive but not specific.


===Presentation===
===Presentation===
*Severity of presentation is broad.  Patient may appear toxic or may have silent chorioamnionitis, which still puts fetus at risk for neonatal sepsis.
*Severity of presentation is broad.  Patient may appear toxic or may have silent chorioamnionitis, which still puts fetus at risk for [[neonatal sepsis]].


==Differential Diagnosis==
==Differential Diagnosis==
{{Abdominal Pain Pregnancy DDX}}
{{Abdominal Pain Pregnancy DDX}}
*Extra-amniotic infections such as [[pyelonephritis]], [[appendicitis]], [[pneumonia]]
*Extra-amniotic infections such as [[pyelonephritis]], [[appendicitis]], [[pneumonia]]


Line 51: Line 53:


==Management==
==Management==
*[[Ampicillin]] IV 2g Q6H AND [[Gentamicin]] IV 1.5 mg/kg Q8H
*[[Ampicillin]] IV 2g Q6H AND [[Gentamicin]] IV 5mg/kg once daily (adjust based on renal function) <ref>Snyder M. et al. Clinical inquiries. What treatment approach to intrapartum maternal fever has the best fetal outcomes?. J Fam Pract. May 2007;56(5):401-2</ref> <ref>Lyell DJ, Pullen K, Fuh K, Zamah AM, Caughey AB, Benitz W, El-Sayed YY. Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):344-9</ref>
*Alternative antibiotic regimens:
*Alternative antibiotic regimens:
**[[Ampicillin-sulbactam]] IV 2g Q6H
**[[Ampicillin-sulbactam]] IV 2g Q6H
Line 57: Line 59:
**[[Cefoxitin]] IV 2g Q4H
**[[Cefoxitin]] IV 2g Q4H
*Can only be considered cured with delivery of infected products of conception
*Can only be considered cured with delivery of infected products of conception
*After delivery, treat like [[postpartum endometritis]] with clindamycin plus gentamycin


==Disposition==
==Disposition==
Given concern for neonatal sepsis, patients should be admitted for IV antibiotics, supportive care, and possible early delivery
Given concern for neonatal sepsis, patients should be admitted for IV antibiotics, supportive care, and possible early delivery<ref>Driscoll SG. Chorioamnionitis: perinatal morbidity and mortality. Pediatr Infect Dis.  1986;5</ref>


==Complications==
==Complications==
*[[Placental abruption]]
*[[Placental abruption]]
*Premature birth
*[[preterm labor|Premature birth]]
*Neonatal sepsis
*[[Neonatal sepsis]]
*Neonatal death
*Neonatal death
*Cerebral palsy
*[[Cerebral palsy]]
*Maternal [[sepsis]]
*Maternal [[sepsis]]
*Need for cesarean delivery
*Need for cesarean delivery
*Postpartum hemorrhage
*[[Postpartum hemorrhage]]


==See Also==
==See Also==
Line 76: Line 79:
==External Links==
==External Links==


==Sources==
==References==
*Rosen’s
<references/>
*Tintinalli’s
*UpToDate
*Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21 (2003): 695-710.
*Apantaku O, Mulik V. Maternal intra-partum fever. J Obstet Gynaecol. 2007 Jan; 27(1):12-5.


<references/>
[[Category:OBGYN]]
[[Category:ID]]

Revision as of 20:04, 29 November 2020

Background

  • Also known as intra-amniotic infection[1]
  • Bacterial infection of fetal amnion and chorion membranes
  • Most commonly an ascending infection from normal vaginal flora

Risk Factors

  • Young age
  • Low socioeconomic status
  • Multiple vaginal examinations
  • Nulliparity
  • Extended duration of labor and ruptured membranes
  • Pre-existing genital tract infections

Microbiology

Clinical Features

Signs and Symptoms

  • Maternal fever (intra-partum temperature 102.2°F (≥39.0°C) once, OR two temperatures between >100.4°F - 102.2°F measured 30 min apart) with no other clear infectious source [2] PLUS
  • One or more of the following
    • Fetal tachycardia (>160-180 beats/min)
    • Purulent or foul-smelling amniotic fluid or vaginal discharge
    • Maternal leukocytosis (total blood leukocyte count >15,000/mm3)
  • Maternal tachycardia and uterine tenderness, suggestive but not specific.

Presentation

  • Severity of presentation is broad. Patient may appear toxic or may have silent chorioamnionitis, which still puts fetus at risk for neonatal sepsis.

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time

Workup

Exam

  • Avoid digital cervical exam
  • Speculum exam should be done with sterile speculum

Management

Disposition

Given concern for neonatal sepsis, patients should be admitted for IV antibiotics, supportive care, and possible early delivery[5]

Complications

See Also

External Links

References

  1. ↑ Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21 (2003): 695-710.
  2. ↑ Higgins RD, Saade G, Polin RA, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a workshop. Obstet Gynecol 2016; 127:426
  3. ↑ Snyder M. et al. Clinical inquiries. What treatment approach to intrapartum maternal fever has the best fetal outcomes?. J Fam Pract. May 2007;56(5):401-2
  4. ↑ Lyell DJ, Pullen K, Fuh K, Zamah AM, Caughey AB, Benitz W, El-Sayed YY. Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: a randomized controlled trial. Obstet Gynecol. 2010 Feb;115(2 Pt 1):344-9
  5. ↑ Driscoll SG. Chorioamnionitis: perinatal morbidity and mortality. Pediatr Infect Dis. 1986;5
Retrieved from "https://www.wikem.org/w/index.php?title=Chorioamnionitis&oldid=286530"