Chorioamnionitis: Difference between revisions
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* Typically treated with [[ampicillin]] q6h and [[gentamicin]] q8-24h until delivery, with or without [[clindamycin]] or [[metronidazole]] |
* Typically treated with [[ampicillin]] q6h and [[gentamicin]] q8-24h until delivery, with or without [[clindamycin]] or [[metronidazole]] |
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* Duration is until delivery followed by one further dose of antibiotics |
* Duration is until delivery followed by one further dose of antibiotics |
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== Prevention == |
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* In patients with [[preterm premature rupture of membranes]] (PPROM), the risk of chorioamnionitis is high and they should receive prophylactic [[ampicillin]] and [[erythromycin]] (or [[azithromycin]]) (per ORACLE I and II trials) |
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** Often given IV for 2 days followed by oral for a total of 7 to 10 days |
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[[Category:Obstetrical infections]] |
[[Category:Obstetrical infections]] |
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Revision as of 13:53, 10 December 2021
Background
- Ascending bacterial infection leading to inflammation of the membranes and placenta
- Also called intraamniotic infection
Microbiology
- Usually polymicrobial
- Ureaplasma urealyticum (47%)
- Mycoplasma hominis (30%)
- Gardnerella vaginalis (25%)
- Bacteroides species (30%)
- Group B streptococcus (15%)
- Escherichia coli (8%)
Epidemiology
- 1 to 4% of all birth
- More common with preterm delivery, PROM, prolonged labour, smoking/alcohol/drug use, multiple vaginal examination, internal monitoring of labour, bacterial vaginosis, colonization by group B streptococcus, and nulliparity
Risk Factors
- Prolonged rupture of membranes (including PPROM) ≥12 hours or ≥18 hours
- Prolonged labour, with second stage >2 hours or active labour >12 hours
- Multiple digital exams with membrane rupture ≥3 exams
- Nulliparity
- Colonization with group B Streptococcus
- Bacterial vaginosis
- Alcohol and tobacco use
- Meconium-stained amniotic fluid
- Internal monitoring of the fetus
- Epidural anaesthesia
Clinical Manifestations
- Fever, tenderness over the uterine fundus, maternal tachycardia, fetal tachycardia
- May have purulent or malodorous amniotic fluid
- Can be complicated by endometritis, pelvic abscess, surgical site infection, bacteremia, postpartum hemorrhage, and poor neonatal outcomes
Management
- Typically treated with ampicillin q6h and gentamicin q8-24h until delivery, with or without clindamycin or metronidazole
- Duration is until delivery followed by one further dose of antibiotics
Prevention
- In patients with preterm premature rupture of membranes (PPROM), the risk of chorioamnionitis is high and they should receive prophylactic ampicillin and erythromycin (or azithromycin) (per ORACLE I and II trials)
- Often given IV for 2 days followed by oral for a total of 7 to 10 days
References
- a b Alan T.N. Tita, William W. Andrews. Diagnosis and Management of Clinical Chorioamnionitis. Clinics in Perinatology. 2010;37(2):339-354. doi:10.1016/j.clp.2010.02.003.
