Chorioamnionitis (Amnionitis, Intra-Amniotic Infection)
Management of Chorioamnionitis
1. Consult the obstetrician. 2. Immediately initiate intrapartum IV antibiotic treatment. Ampicillin 2 grams q6h or penicillin 5 million U q6h plus an IV aminoglycoside such gentamycin 1.5 mg/kg every q8h are the most extensively tested combinations. Antibiotics are continued until the patient has been a free afebrile and a asymptomatic for 24 hours, when they can be discontinued and the patient can be discharged. And oral course follows only when the patient has been documented with staphylococcus bacteremia. 3. Facilitate delivery. Infection is not an into indication for sister in delivery. 4. Closely observe the fetal heart rate. Tachycardia and decreased variability occur in 75% of these infants. 5. Observe for dysfunctional labor which occurs more frequently with Chorioamnionitis. 6. Notify the pediatric provider. Prepare for a potentially ill infant.
Chorioamnionitis
An infection that usually results from ascending bacteria. The Infection sometimes results from transplacental dissemination of microorganisms. Or less commonly, infection maybe caused by obstetric procedures such as cervical cerclage, amniocentesis, interuterine transfusion, or percutaneous umbilical cord sampling (PUBS).
Laboratory findings
Elevated W BC count with shift to the left. Amniocentesis will yield fluid that has positive Gram stain or culture, with WBC count greater >15,000 cells mm, glucose <10 to 15 mg/dl, interleukin-6, >7.9 ng/mL, leukocyte esterase >1+ reaction. Blood cultures are positive in 5% to temper cent of patients.
Incidents of intra-amniotic infection in relation to the link of ruptured membranes
Hey 1.6% to 29% chance within 24 hours of rupture of membranes at term depending on Race, socioeconomic factors, recipient a prenatal care, and just gestational age. The incidence of intra-partial fever rises with delivery later than 24 hours intern pregnancies, if the Laten phase Extends beyond 72 hours, the perinatal mortality rate is significantly increased.
Risk factors for Chorioamnionitis
Internal monitor use, lengthy labor, low socioeconomic status, meconium stained amniotic fluid, multiple vaginal examinations, nulliparity, pre-existing infection, prolonged rupture of membranes, young age.
Clinical findings of Chorioamnionitis
Maternal fever, maternal and fetal tachycardia, and, in advanced cases, uterine tenderness, purulent amniotic fluid, and luekocytosis.
