Chorioamnionitis: Difference between revisions
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== Background == |
== Background == |
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| − | * Ascending bacterial infection leading to inflammation of the |
+ | * Ascending bacterial infection leading to inflammation of the amniotic cavity and chorioamnionic memranes |
| − | * Also called intraamniotic infection |
+ | * Also called intraamniotic infection, amnionitis, amnionic fluid infection |
=== Microbiology === |
=== Microbiology === |
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* Usually '''polymicrobial''' |
* Usually '''polymicrobial''' |
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| + | * Non-stainable: |
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| − | * [[Ureaplasma urealyticum]] (47%) |
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| − | * [[ |
+ | ** [[Ureaplasma urealyticum]] (47%) |
| − | * [[ |
+ | ** [[Mycoplasma hominis]] (30%) |
| + | * Gram-positives: |
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| ⚫ | |||
| − | * [[Group B streptococcus]] (15%) |
+ | ** [[Group B streptococcus]] (15%) |
| − | * [[ |
+ | ** [[Enterococcus faecalis]] |
| + | ** [[Staphylococcus aureus]] |
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| + | ** Other [[streptococci]] |
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| + | * Gram-negatives: |
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| + | ** [[Escherichia coli]] (8%) |
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| + | ** Other [[gram-negative bacilli]] |
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| + | * Anaerobes: |
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| ⚫ | |||
| + | ** [[Gardnerella vaginalis]] (25%) |
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| + | ** [[Fusobacterium]] |
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| + | ** [[Peptostreptococcus]], [[Peptococcus]], [[Clostridium]] |
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=== Epidemiology === |
=== Epidemiology === |
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Latest revision as of 10:56, 3 March 2023
Background
- Ascending bacterial infection leading to inflammation of the amniotic cavity and chorioamnionic memranes
- Also called intraamniotic infection, amnionitis, amnionic fluid infection
Microbiology
- Usually polymicrobial
- Non-stainable:
- Ureaplasma urealyticum (47%)
- Mycoplasma hominis (30%)
- Gram-positives:
- Gram-negatives:
- Escherichia coli (8%)
- Other gram-negative bacilli
- Anaerobes:
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 metronidazole1
- 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)1
- 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.
