Chorioamnionitis

Def.

(Intra-amniotic infection) bacteria entered any tissues /membranes around fetus (chorion,amnion,placenta, amniotic fluid)

Treatments

Antibiotics

Deliver baby early

Risk factors

Longer duration of membrane rupture

Alcohol/drug abuse, smoking

Epidural anesthesia

Group B streptococcus

STD OR STI

Multiple vaginal examination

Internal monitoring of labor

American American ethnicity

Prolonged labor

Nulliparity

Bacterial viginosis

Immunocompromised status

Meconium satined amniotic fluid

Pathogenesis (route)

Cervix and vagina

hematogenic /transplacental

Iatrogenic infection: Amniocentesis / chorionic billows samplig

Peritenium via fallopian tube

Organisms

65% involve 2 or more of

Ureaplasma

Urealyticum

Mycoplasma hominis (genital mycoplasma)

Mycoplasmas

Anaerobes

Aerobes

Gardnerella vaginalis (25%)

Bacteroides (30%)

Group B streptococcus (GBS 15%)

Gram-negative rods ;Escherichia coili (8%)

Diagnosis

Hx

Uterine fundal tenderness

Fever

Maternal tachycardia >100 /min

Fetal tachycardia >160/min

Purulent/foul smelling discharge

Sweating

Others:

Preterm labor

PPROM

Premature ROM(>37 wks)

Management

Laboratory tests

CBC,CRP

Amniotic fluid testing

Urine test

Vaginal cultures

US (baby health)

Vaginal examination ((if there is leaking)

Differential diagnosis

Pyelonephritis

Influenza

Appendicitis

Pneumonia

Thrombophlebitis

Round ligament pain

Colitis

Connective tissue disorderes

Placental abruption

Antibiotics

Ampicillin Q6 Gentamycin Q8 -24hr (till delivery)

Severe tachycardia for CS and post delivery give-> clindamycin/metronidazole Q8

Antipyretic

Decrease fetal HR

Decrease risk of neonatal encephalopathies

Complications

Maternal

CS

End-myo-metritis

Wound infection

Pelvic abcess

Bacteremia

Postpartum hemorrhage

Septic shock

Disseminated intravascular coagulation

Adult respiratory distress syndrome

Maternal death

Fetal

Pneumonia

Asphaxia

Neonatal sepsis

Intravascular hemorrhage (IVH)

Septic shock

Early onset neonatal sepsis

Perinatal death

Fetal death

Cerebral white matter damage

Cerebral palsy

Prevention

Antibiotics

Ampicillin

Erythromycin