Chorioamnionitis
DEFINITION
Infection of the chorion, amnion and amniotic fluid typically due to ascending infection by organisms from normal
vaginal flora. Most often associated with prolonged labour. AETIOLOGY /EPIDEMIOLOGY
Incidence 1-5% of term pregnancies and up to **25% in preterm deliveries
• Most commonly results from organisms ascending from vagina
• May also result from haematogenous spread
• Predominant microorganisms include GBS, Bacteroides and Prevotella species, E. coli and anaerobic Streptococcus
Medscape: GBS infections are no longer the major cause of EOS. Gram-negative bacteria are now most
predominant particularly Escherichia coli
RISK FACTORS
***Labour-related:
• **Prolonged ROM
• Preterm labour
• Long labour
• Multiple vaginal exams during labour - risk of developing chorioamnionitis increases with each vaginal examination
that is performed in the final month of pregnancy, including during labor
• Internal monitoring (Eg. fetal scalp electrode!)
**Infections:
• Bacterial vaginosis and other vaginal infections – *BV is also associated with preterm labour
• UTI in pregnancy
CLINICAL FEATURES
***Pay attention to these if you get a patient in the OSCE with fever esp. immediately post delivery!! REMEMBER to ask about FOUL/PURULENT cervical discharge/lochia!!
• (Temperature, Tachycardia, Tenderness, Foul discharge)
These are CLASSIC features!!! – therefore must know all:
1. Maternal fever - (intrapartum temperature >100.4°F or >37.8°C) à Most frequently observed sign
2. Maternal tachycardia
3. Fetal tachycardia
4. Uterine tenderness
5. Foul and purulent cervical discharge or lochia* [See end of notes]
6. [Along with maternal leukocytosis]
• **NB: Some patients ASYMPTOMATIC – “Silent chorioamnionitis”!! –
• Other pts may also be hypotensive, diaphoretic, cold + clammy (Septic shock)
• Fetus may have non-specific signs of sepsis (EOS = Early onset sepsis) – assc with WCC and CRP
Infection of the chorion, amnion and amniotic fluid typically due to ascending infection by organisms from normal
vaginal flora. Most often associated with prolonged labour. AETIOLOGY /EPIDEMIOLOGY
Incidence 1-5% of term pregnancies and up to **25% in preterm deliveries
• Most commonly results from organisms ascending from vagina
• May also result from haematogenous spread
• Predominant microorganisms include GBS, Bacteroides and Prevotella species, E. coli and anaerobic Streptococcus
Medscape: GBS infections are no longer the major cause of EOS. Gram-negative bacteria are now most
predominant particularly Escherichia coli
RISK FACTORS
***Labour-related:
• **Prolonged ROM
• Preterm labour
• Long labour
• Multiple vaginal exams during labour - risk of developing chorioamnionitis increases with each vaginal examination
that is performed in the final month of pregnancy, including during labor
• Internal monitoring (Eg. fetal scalp electrode!)
**Infections:
• Bacterial vaginosis and other vaginal infections – *BV is also associated with preterm labour
• UTI in pregnancy
CLINICAL FEATURES
***Pay attention to these if you get a patient in the OSCE with fever esp. immediately post delivery!! REMEMBER to ask about FOUL/PURULENT cervical discharge/lochia!!
• (Temperature, Tachycardia, Tenderness, Foul discharge)
These are CLASSIC features!!! – therefore must know all:
1. Maternal fever - (intrapartum temperature >100.4°F or >37.8°C) à Most frequently observed sign
2. Maternal tachycardia
3. Fetal tachycardia
4. Uterine tenderness
5. Foul and purulent cervical discharge or lochia* [See end of notes]
6. [Along with maternal leukocytosis]
• **NB: Some patients ASYMPTOMATIC – “Silent chorioamnionitis”!! –
• Other pts may also be hypotensive, diaphoretic, cold + clammy (Septic shock)
• Fetus may have non-specific signs of sepsis (EOS = Early onset sepsis) – assc with WCC and CRP
Comments
Post a Comment