Maternal fever (intrapartum temperature > 37.8°C) is the most common symptom of chorioamnionitis. Other characteristic features of the disease are fetal tachycardia, purulent amniotic fluid, uterine tenderness and maternal leukocytosis. When two or more of these symptoms are observed in the patient, the risk of neonatal sepsis increases.

Though in some cases, the pregnant women with chorioamnionitis may show no signs or symptoms, in some cases, they may appear ill, even toxic and hypotensive with cool or clammy skin. The symptoms of the suspected sepsis in the neonate and mother are often nonspecific and include findings such as behavioral abnormalities, tachypnea, cyanosis, apnea, pulmonary hemorrhage, tachycardia, vomiting and diarrhea, abnormalities in thermal regulation, pallor, overt bleeding and hypotension [7] [8].

• Hemophilia A

  Acquired hemophilia A (AHA) is a serious and rare complication of pregnancy, caused by autoantibodies to coagulation factor VIII after delivery. [ncbi.nlm.nih.gov]

• Inflammation

  Table 2: The Role of Choriomnionitis and Funisitis to Preterm Birth Development Labor RR 95% CI P-value Preterm Aterm Amniotic membrane Inflammation 10 1 3,86 1,61-9,29 0,001 Normal 4 13 Umbilical cord Inflammation 11 4 3,18 1,13-8,98 0,008 Normal 3 10 [biomedpharmajournal.org]

  […] with intra-amniotic inflammation. [ncbi.nlm.nih.gov]

  From Wikidata Jump to navigation Jump to search placenta disease that is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection fetal membraneitis fetal membrane inflammation intra-amniotic infection edit English chorioamnionitis [wikidata.org]

• Fever

  Intrapartum maternal fever and neonatal outcome. Pediatrics 2000;105:8–13. ⇦ Impey L, Greenwood C, MacQuillan K, Reynolds M, Sheil O. Fever in labour and neonatal encephalopathy: a prospective cohort study. [acog.org]

  How long antibiotics are given varies, depending on individual circumstances (eg, how high the fever was, when the fever last spiked in relation to delivery). [merckmanuals.com]

  Does every fever intrapartum need to be treated? There are lots of things that can cause fever intrapartum or immediately postpartum other than chorioamnionitis, such as: Misoprostol use and other types of drug fevers. Epidural use. [creogsovercoffee.com]

  The mother had high fever and marked uterine tenderness, and the infant had poor Apgar scores, fever, and pulmonary infiltrates. Both recovered after receiving specific antibiotics. [ncbi.nlm.nih.gov]

  However, a persistent low-grade fever or any fever over 101° F is a strong clinical sign of a potential infection. Fever is a documented clinical symptom in almost 100% of all chorioamnionitis cases. [birthinjuryhelpcenter.org]

• Sepsis

  The International Concensus Conference on Pediatric Sepsis in 2002 stated that there was an aggrement of the definition in SIRS, sepsis, severe sepsis, and septic shock. [biomedpharmajournal.org]

  Antibiotics should be administered within one hour of recognition of severe sepsis. Serum lactate should be measured within six hours of the suspicion of severe sepsis in order to guide management. [oapublishinglondon.com]

  The conundrum of early-onset sepsis. Pediatrics 2014;133:1122–3. ⇦ Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. [acog.org]

  CONCLUSION: Daily dosing of gentamicin using ideal body weight is effective in successful treatment of chorioamnionitis without development endometritis and/or neonatal sepsis across different ethnicities. [ncbi.nlm.nih.gov]

• Weakness

  CONCLUSIONS: The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA. [ncbi.nlm.nih.gov]

  For infants, a diagnosis is generally made, based upon the following symptoms: Weak cries, poor sucking, and fatigue Pulmonary problems, such as respiratory distress, apnea, and cyanosis Gastrointestinal problems, which may include bloody stools, vomiting [birthinjuryguide.org]

  Yeast Overgrowth in the Human Body weaknesses and infectious conditions are usually worsened by the presence of Candida parasites throughout the body. Laura in the Kitchen 1108146 views Saranac Nut Brown Ale – Beer Evaluation. [compas-ict.eu]

  Examination for suspected sepsis in the neonate of a mother with chorioamnionitis often yields nonspecific and subtle findings, which may include the following: Behavioral abnormalities (eg, lethargy, hypotonia, weak cry, poor suck) Pulmonary: Tachypnea [emedicine.medscape.com]

• Falling

  The fall also caused a back injury usually attributed to falls from great distances. The patient has permanent pain, recurring diarrhea, and depression as a result of the injuries. [mdedge.com]

  […] premature rupture of the membranes, there is greater risk of chorioamnionitis (though sometimes it means there already is chorioamnionitis), and if the baby suffers injuries such as brain damage or nerve injuries due to a doctor's actions or omissions that fall [defranciscolaw.com]

  View Article PubMed Google Scholar Ladfors L, Mattsson LA, Eriksson M, Fall O: A randomised trial of two expectant managements of prelabour rupture of the membranes at 34 to 42 weeks. [bmcpregnancychildbirth.biomedcentral.com]

  The risk falls into three broad categories: prolonged labor or complicated pregnancies, abnormal vaginal flora, and preterm birth. [glowm.com]

• Intestinal Perforation

  Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation. Pediatrics. 2007 Dec. 120(6):e1458-64. [Medline]. Dulay AT, Buhimschi IA, Zhao G, et al. [emedicine.medscape.com]

• Nausea

  Watch out for these symptoms of UTIs: high fever nausea vomiting pain in your sides or lower back discomfort or pain when passing urine blood in the urine If you have any of these symptoms, contact your healthcare team as soon as possible as you may need [tommys.org]

  […] koortslip is lastig en pijnlijk maar is in principe niet geaarlijk voor voor een candida-infectie dit heeft geen gevolgen voor de zwangerschap Does anyone have a recipe for bread that can be made If you develop a candida overgrowth constipation bloating gas nausea [yourbuzz.eu]

  Gastrointestinal symptoms including nausea, vomiting, and distention may be present. The most striking physical finding is a tender tubular mass on abdominal or pelvic examination; this is present in half of patients. [glowm.com]

• Tachycardia

  In addition one of the following should also be documented: Maternal tachycardia (>100 bpm) Fetal tachycardia (>160 bpm) Uterine tenderness Foul smelling/ purulent discharge Maternal leukocytosis (>15,000 cell/cubic mm) Subclinical infection can be assessed [obtsguidelines.org]

  The clinical criteria for chorioamnionitis found in preterm or term women include maternal fever combined with 2 or more findings of maternal tachycardia, fetal tachycardia, leukocytosis, uterine tenderness, and/or malodorous amniotic fluid. [ncbi.nlm.nih.gov]

  Tachycardia: maternal and fetal tachycardia (fast heart beat) are the second most common symptom of chorioamnionitis. [birthinjuryhelpcenter.org]

  Clinical diagnosis is based on the presence of maternal fever (>38°C) and two of the following: maternal leucocytosis or leucopenia, maternal tachycardia (>100 bpm), fetal tachycardia (>160 bpm), uterine tenderness, and foul-smelling amniotic fluid 4. [oapublishinglondon.com]

• Hypertension

  KEYWORDS: Histologic chorioamnionitis; Preterm newborn; Pulmonary hypertension [ncbi.nlm.nih.gov]

  see Hypertension, complicating pregnancy hypertensive hyperthyroidism 648.1 hypothyroidism 648.1 hysteralgia 646.8 icterus gravis 646.7 incarceration, uterus 654.3 incompetent cervix (os) 654.5 infection 647.9 infective and parasitic diseases NEC 647.8 [icd9data.com]

  […] of internal monitors, labor greater than 10 hours, hypertension, and diabetes, the association between the intra-amniotic infection in both pregnancies still held. [medpagetoday.com]

  Those with hypertension and diabetes also were excluded because of the high rates of labor induction associated with these diseases. [aafp.org]

• Vaginal Discharge

  Pulsed field gel electrophoresis showed that isolates from the blood, urine, and vaginal discharge were genetically identical. Intravenous pyelography revealed that she had a bilateral completed double ureter. [ncbi.nlm.nih.gov]

  Foul odor of the vaginal discharge, color change of amniotic fluid from clear to light yellow to green, and an increase in the purulence of vaginal drainage are all consistent with chorioamnionitis. [medical-dictionary.thefreedictionary.com]

  Findings of rapid heart rate (maternal tachycardia and/or fetal tachycardia), a mother’s elevated white blood cell count (leukocytosis), uterine tenderness, and/or malodorous amniotic fluid or vaginal discharge can also aid in diagnosing chorioamnionitis [yostlaw.com]

  Symptoms include maternal fever, increased maternal or fetal heart rate, tenderness in the abdomen and funky-smelling vaginal discharge. If infection is suspected, you’ll get an IV of antibiotics, and the baby will be delivered ASAP. [thebump.com]

• Foul Smelling Vaginal Discharge

  Other signs include appearing ill, sweating profusely, foul-smelling vaginal discharge, significantly rapid heart rate, or a high white blood cell count. [thurswell.com]

  Look out for these symptoms of chorioamnionitis: high temperature a foul-smelling vaginal discharge fast pulse rate pain in your abdomen. [tommys.org]

  The patient declined amniocentesis for cerclage and was treated with pelvic rest and vaginal progesterone. Five days later, she arrived at the emergency department with foul-smelling vaginal discharge. [wwwnc.cdc.gov]

  Fever [5] Maternal tachycardia (cardiac arrhythmia) Increased fetal heart rate (fetal tachycardia) [6] Sweating Uterine tenderness and pain Foul smelling vaginal discharge [5] Maternal leukocytosis (blood leukocyte count greater than 15,000-18,000 cells [pregmed.org]

Laboratory tests

• For asymptomatic pregnant women presenting preterm labor, the following tests must be performed namely examination of amniotic fluid, maternal blood and urine analysis, maternal blood group-B streptococcal screening. 
• Tests for febrile pregnant women with suspected chorioamnionitis include complete blood count, C-reactive protein, Alpha1-proteinase inhibitor complex, and serum interleukin-6 levels. 
• Evaluation of the amniotic fluid are bacterial cultures, Gram staining, pH levels, leukocyte count, levels of glucose in the blood, polymerase chain reaction, proteomic profiling, etc. 
• Other diagnostic tests for early onset neonatal sepsis are determination of the levels of procalcitonin, serum interleukin-6 or cytokine, bacterial antigen detection in the blood, etc. [9]

Imaging

Since short cervix is a risk factor for chorioamnionitis, ultrasonography can help to detect this altered anatomy. Imaging studies helps to ascertain the health of the fetus on a regular basis [9].

• Candida

  Antenatal treatment for Candida chorioamnionitis has not been established. [ncbi.nlm.nih.gov]

• White Matter Lesions

  Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits. Am J Obstet Gynecol 1997;177797- 802PubMedGoogle ScholarCrossref 17. [jamanetwork.com]

  Using a rabbit model, Yoon and coworkers demonstrated that intrauterine infection leads to white matter lesions in the fetal brain that closely resemble the lesions of infection-associated CP seen in the human infant.6 Similar observations have been made [mdedge.com]

  Yoon BH, Jun JK, Romero R, Park KH, Gomez R, Choi JH, Kim IO: Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1β, and tumor necrosis factor-α), neonatal brain white matter lesions, and cerebral palsy. [karger.com]

  matter lesions characterized by increased karyorrhexis, rarefaction, disorganization of white matter, and increased apoptosis in the cerebral cortex. 80 The findings of increased umbilical cord IL-6 and neonatal proinflammatory cytokine concentrations [glowm.com]

Therapy of chorioamnionitis includes early delivery and supportive care with the use of safe antibiotics. Some of the antibiotics to manage the disease are crystalline penicillin G, clindamycin, ampicillin, gentamicin, and cefotaxime.

Supportive care of the neonates are providing warmth, full resuscitation when needed, treatment of hypervolemia, respiratory acidosis, surfactant replacement therapy, glucose homeostasis and monitoring of the vital signs. Assessment of the thrombocytopenia is one of the important aspects that need to be looked into.

Some surgical options are also available for early onset bacterial infections in the neonate; however, they are rarely used. The conditions that warrant the surgical intervention are epidural and subcutaneous abscess, infections located in the pleural space, bone and joint infections, and similar conditions [10].

The long-term prognosis for both the mother with chorioamnionitis and the neonate is excellent. The fertility of the women is not compromised. The child born preterm may, however, suffer from the long-term complications such as neurologic impairment and chronic lung disease [11].

Complications

Some of the complications of chorioamnionitis are infection in the abdomen and pelvic regions, endometriosis, sepsis, and blood clots in the pelvis and lungs. Complications from bacterial infection in the newborn also include sepsis, meningitis and respiratory problems [12].

When the protective mechanism of the maternal urogenital tract fails during pregnancy, there is an increase in the indigenous microbial flora or influx of highly pathogenic microorganisms in the urogenital region. In pregnant women, therefore, urogenital hygiene is important. When the microorganism reach the placenta, it leads to infection. Short cervix, bacterial virulence factors and toxin production are some of the risk factors of this disease. In healthy pregnant women, bacteria such as lactobacilli, is a natural antibiotic of the vagina and cervix, and phagocytes also help to prevent infection.

However, in women with chorioamnionitis, this host protection is compromised. Oral and rectal hygiene is therefore extremely important for normal urogenital colonization. Some of the clinical events associated with chorioamnionitis are history of preterm labor or premature birth, and premature or prolonged ruptured fetal membranes. Evidences also suggest that epidural anesthesia may be associated with maternal fever or fetal tachycardia [2] [3].

In underdeveloped countries, the main reason for chorioamnionitis is the premature rupture of the membranes, which is often associated with a high mortality rate. In Africa, malnourished pregnant women are at a higher risk of having ascending urogenital infection causing chorioamnionitis.

This is believed to be due to decrease in the host defense factors. In developed countries, women receive optimum care during pregnancy with proper nutrition; hence the incidence of infection is greatly reduced [4].

• Abnormal bacterial colonization: Due to the abnormal colonization in the distal colon, abnormal vaginal and cervical microbial environments are created. Studies have confirmed that there are types of bacteria, which may ascend and rupture the fetal membrane and initiate the infection in amniotic fluid of the fetus causing chorioamnionitis. 
• Urinary tract infection leads to an easy access of the bacterial pathogen to the vagina, increasing the risk of neonatal sepsis. 
• Premature labor is associated with bacterial vaginosis. Early screening and treatment of vaginosis may prevent the preterm birth. 
• Some other causes of the condition are related to cervical insufficiency, release of vaginal prostaglandins, etc. [5] [6]

• Urinary tract infections, if diagnosed, must be treated immediately. 
• Risk of preterm labor must be determined at the earliest. 
• Chances of development of chorioamnionitis can be reduced by regularly attending the prenatal check-up, preventing bacterial vaginosis, practicing safe sex, and getting the routine vaginal culture done, when indicated.

Chorioamnionitis is a common complication of pregnancy. It is often associated with maternal fever and other long-term adverse outcomes such as postpartum infections, sepsis, premature birth, neonatal sepsis, brain injury and stillbirth, cerebral palsy and neurodevelopmental disabilities.

There exists a mechanistic relationship between the intraamniotic infection and preterm delivery. Ongoing research in the field has provided evidence for better methods of diagnosis, prevention and treatment of the condition [1].

Definition

Chorioamnionitis is a common complication of pregnancy which is associated with maternal fever and long-term adverse outcomes such as sepsis, brain injury, and stillbirth. Recent research provides better evidence of diagnosis, prevention and treatment of the condition. 

Cause

Abnormal bacterial colonization, urinary tract infection, premature labor associated with bacterial vaginosis, cervical insufficiency and release of vaginal prostaglandins are some of the important causes of chorioamnionitis. 

Symptoms

Some of the symptoms associated with this disease are maternal fever, illness, low blood pressure, and clammy skin.

Diagnosis

• For pregnant women who are asymptomatic, laboratory tests such as examination of amniotic fluid, maternal blood, and Group-B streptococcal screening and urine analysis are performed. 
• For the febrile pregnant women with suspected chorioamnionitis, complete blood count, C-reactive protein, Alpha1-proteinase inhibitor complex, serum interleukin-6 levels is done. 
• Tests such as bacterial cultures, Gram staining, pH levels and polymerase chain reaction, ultrasonography may also be performed. 

Treatment

Women with chorioamnionitis are treated with antibiotics such as clindamycin, ampicillin, gentamicin, and cefotaxime. Supportive care of the neonates such as providing warmth, full resuscitation, glucose homeostasis and monitoring of the vital signs is important. Assessment of the thrombocytopenia is one of the important aspects that need to be looked into. Some surgical options are available for early onset bacterial infections in the neonate; though, they are rarely used.

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