Chorioamnionitis

Published on 30/05/2015 by admin

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Last modified 30/05/2015

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Chapter 204 Chorioamnionitis

INTRODUCTION

Description: Chorioamnionitis is inflammation of the fetal membranes. This may be associated with prolonged or premature rupture of the membranes or a primary cause of premature labor.
Prevalence: 50% of premature deliveries.
Predominant age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Infection by organisms ascending from the vaginal canal, most often when the membranes have been ruptured. Studies indicate that bacteria (specifically Escherichia coli) can permeate intact chorioamnionic membranes. Infection may also occur by hematogenous, transabdominal, or transfallopian routes.
Risk factors: Prolonged rupture of the membranes, frequent pelvic examinations, bacterial or trichomonas vaginitis, vaginal or cervical infection with Chlamydia trachomatis, smoking, anemia, vaginal bleeding.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• May be asymptomatic
• Fever (>100.5°F, 38°C)
• Tachycardia (maternal and fetal)
• Uterine irritability and tenderness
• May result in premature rupture of the membranes or preterm labor
• Maternal signs of infection (elevated white blood count and sedimentation rate)
• Purulent cervical discharge (late)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Placental abruption
• Intra-abdominal infection (e.g., appendicitis)
• Pyelonephritis
• Pneumonia
• Pulmonary embolism
• Wound infection (episiotomy, abdominal incision following cesarean delivery or tubal ligation)
• Breast engorgement
• Drug fever

Associated Conditions: Endometritis, fetal infections (pneumonia, skin infections), and oligohydramnios have been linked to clinical chorioamnionitis. Dysfunctional labor and postpartum hemorrhage are more common. Cerebral palsy has been linked to intrauterine infection.

Workup and Evaluation

Laboratory: White blood count and red cell sedimentation rate. Gram stain of amniotic fluid (a negative test carries a 99% specificity). Cultures may be obtained and may be of assistance in management, but the diagnosis is often made on clinical grounds. (Amniocentesis for culture has not been shown to improve pregnancy outcome. There is no clear evidence to support the use of C-reactive protein for the early diagnosis of chorioamnionitis.)
Imaging: No imaging indicated.
Special Tests: A biophysical profile of the fetus may be of assistance in planning management (if time and maternal condition permit).
Diagnostic Procedures: Physical examination, cultures.

Pathologic Findings

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