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