OB: Chorioamnionitis

What are other causes of isolated intrapartum fever?

1. Epidural 2. UTI 3. URTI 4. Cytotec

What are some lab tests perform on amniotic fluid to diagnose chorio?

1. Gram Stain 2. Culture 3. Glucose Level (<14mg/dL) 4. WBC (>30 cells) [cant have a bloody tap] 5. Leukocyte Esterase on urine dipstick

What are the three categories of Intramniotic Infection?

1. Isolated Maternal Fever 2. Suspected intraamniotic infection 3. Confirmed Inntramniotic infection

What are some maternal complications of chorio?

1. Labor dystocia 2. PPH (2/2 to above) 3. Endometritis 4. Peritonitis 5. Spesis 6. Death 7. ARDS

What are the criteria to have a suspected intraamniotic infection?

1. Maternal intrapartum fever PLUS 1 or more of the following: a. Purulent cervical dischagre b. Fetal Tachycardia ( >160bpm for > 10 mins) c. Maternal Leukocytosis (>15,000 w/ Left Shift & in the absence of steroids)

What are some fetal complications of chorio?

1. Neonatal pneumonia 2. Meningitis 3. Sepsis 4. Death 5. CP 6. Bronchopulmonary dysplasia

What are the two ways to have a confirmed case of intraamniotic infection?

1. Positive amniotic fluid testing 2. Placental Pathology

What things are you doing to help treat suspected/confirmed chorio?

1. Tylenol for fever 2. Intrapartum abx 3. Labor augmentation w/ pitocin (if needed)

What is the antibiotic regimen for chorio in patient with a MILD PCN allergy?

1Cefazolin 2g IV q 8h PLUS Gentamicin 2mg/kg IV loading dose + 1.5mg/kg q 8 hours OR Gentamicin 5mg/kg IV q 24 hours

What percentage of TERM pregnancies are affected by chorio?

2-5%

In the TERM pregnancies affected by chorio, what percentage of women have had PROM >24 hours?

40%

What percentage of preterm deliveries are complicated by chorio?

40-70%

In the TERM pregnancies affected by chorio, what percentage of women have PROM?

7%

What is the definition of an isolated maternal fever?

A single oral temp >39C OR An oral temp bxn 38-39C that persists for 30 mins

What is the primary antibiotic regimen for chorio?

Ampicillin 2g IV q 6 hours PLUS Gentamicin 2mg/kg IV loading dose + 1.5mg/kg q 8 hours OR Gentamicin 5mg/kg IV q 24 hours

What is the definition of chorioamnionitis a.k.a. Intraamniotic infection?

An infection resulting in inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, decidua

What is the antibiotic regimen for chorio in patient with a SEVERE PCN allergy?

Clindamycin 900mg IV q 8 hours PLUS Gentamicin 2mg/kg IV loading dose + 1.5mg/kg q 8 hours OR Gentamicin 5mg/kg IV q 24 hours

T or F: Intraamniotic infection alone is an indication for immediate delivery

False Intramaniotic infection ALONE is NOT an indiction for immediate delivery

What is the most important risk factor for developing chorio?

Length of labor Length of ROM

What bacteria is know to hematogenous spread and cause chorio?

Listeria monocytogenes

What physical barrier is present in pregnancy to help prevent the ascension of vaginal flora into the uterine cavity?

Mucus plug

What additional antibiotics should be added postpartum if a patient was diagnosed with chorio and underwent a cesarean delivery?

They should receive 1 extra dose of whatever regimen was started above PLUS Clindamycin 900mg IV x 1 dose OR Metronidazole 500mg IV x 1 dose

What can chorio cause labor dystocia?

Thought to be due to the inflammation causing dysfunctional myometrial contractility

T or F: Intraamniotic infection is rarely an indication for cesarean delivery

True

T or F: Chorio is often polymicrobial

True

T or F: Patient with a Temp >39C and no other clinical signs can be put in the suspected category even though it is considered an isolate maternal fever?

True

T or F: Risk of chorio increases with post-dates?

True

What are some bacterial isolates commonly found with chorio?

Ureaplasma Mycoplasma GBS Gram - rods Gardnerella Bacteroides

What are the most common bacterial isolates in chorio?

Ureaplasma & mycoplasma species

What is the most common way chorio develops?

Usually occurs by ascending bacteria from the lower genital tract to the sterile amniotic cavity

Where does the bacteria usually come from?

Vaginal flora

What are some considerations for postpartum antibiotics after cesarean delivery?

Women who undergo cesarean deliveries should receive 1 additional dose in the postpartum period (Attending specific)

What other ways can chorio develop?

s/p Amnio s/p CVS Hematogenous spread

What are some considerations for postpartum antibiotics after vaginal delivery?

women who undergo vaginal deliveries ay not require postpartum abx BECAUSE they are less likely to develop endometritis (Attending specific)