Chorioamnionitis (Chp. 26)
Prevalence of chorioamnionitis
1-5% of all pregnancies 50-70% of VLBW infants 80% of PPROM
Two types of chorioamnionitis
1. Acute chorioamnionitis 2. Subclinical chorioamnionitis
Management of the exposed chorioamnionitis infant
1. All receive full septic work up (even if they appear healthy) 2. All receive broad spectrum antibiotics until early-onset sepsis ruled out.
Neonatal complications associated with subclinical chorioamnionitis
1. Brain injury 2. Chronic lung disease 3. ROP 4. NEC
Obstetric management of chorioamnionitis
1. Broad-spectrum antibiotics for at least 24 hours 2. Prompt delivery of fetus 3. Antenatal steroids controversial
Neonatal complications associated with acute chorioamnionitis
1. Early-onset sepsis at birth 2. Respiratory distress 3. Cardiovascular instability
Microbes responsible for acute chorioamnionitis
1. GBS 2. E.Colo 3. Strep. viridans
Factors associated with development of clinical chorioamnionitis
1. Maternal colonization of GBS 2. GBS bacteriuria 3. Nulliparity 4. Internal monitoring devices 5. Meconium stained amniotic fluid 6. Serial vaginal exams 7. Increased duration of labor 8. Increased duration of ROM
Clinical chorioamnionitis diagnosis criteria
1. Maternal fever >100.4 PLUS (2) 1. Maternal leukocytosis 2. Maternal and fetal tachycardia 3. Uterine tenderness 4. Foul-smelling or purulent amniotic fluid
Microbes responsible for subclinical chorioamnionitis
1. Ureaplasma urealyticum 2. Mycoplamsa hominis 3. Gardneerella vaginalis
Most common organisms recovered in culture-proven chorioamnionitis?
1. Ureaplasma urealyticum 2. Mycoplasma hominis
How do microbes usually invade the intrauterine space?
Ascending through the cervix from lower genital tract.
How to identify microorganisms in amniotic fluid
Broad-range PCR
Potential sites of intra-amniotic infection
Chorio-decidual space, fetal membranes, placenta, amniotic fluid, umbilical cord, fetus
What antibiotics are contraindicated in maternal chorioamnionitis management?
Co-amoxiclav & erythromycin
Is clinical or histologic chorioamnionitis more common?
Histologic
Histologic chorioamnionitis
Inflammation of the chorion and amnion (placenta)
Chorioamnionitis
Intra-amniotic infection
What symptom can occur from placement of epidural
Maternal Fever (usually occurs within 4-6 hours)
Risk factors associated with chorioamnionitis
Maternal morbidity, preterm birth, early-onset neonatal sepsis, BPD, ROP, periventricular leukomalacia
Why is it difficult to identify women with chorioamnionitis?
Microbial invasion can be chronic and clinically silent.
Clinical chorioamnionitis
Term when characteristic clinical signs of chorioamnionitis are present