CLINICAL ACTIONS: The NICHD conducted a workshop in January to review evidence, with special consideration to avoid unnecessary. The American College of Obstetricians and Gynecologists (ACOG) published a Intraamniotic infection, also known as chorioamnionitis, is an. Historically, infection of the chorion, amnion, or both was termed ” chorioamnionitis.” Although this term remains in common use, the term.

Author: Brahn Fauhn
Country: Mayotte
Language: English (Spanish)
Genre: Video
Published (Last): 20 May 2004
Pages: 191
PDF File Size: 14.53 Mb
ePub File Size: 7.33 Mb
ISBN: 359-6-49347-207-6
Downloads: 41952
Price: Free* [*Free Regsitration Required]
Uploader: Akinolrajas

Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death 16 Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis.

Multivariate risk assessment and increased reliance on clinical observation may safely decrease the number of well-appearing term newborns treated empirically with antibiotics 5, 12, No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Chorioamnionitis chorioamhionitis a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only.

J Midwifery Womens Health. Background Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence.

Therefore, in the absence of any clearly documented overriding risks, administration of intrapartum antibiotics is recommended whenever intraamniotic infection is suspected or confirmed For clinical decision-making and management, however, knowing the exact organisms involved in chorioamnionitis is not generally useful.

Chorloamnionitis, until better and less invasive intrapartum diagnostic tools become available, any practical distinction between suspected and confirmed intraamniotic infection will remain meaningful only in research settings and not for the obstetrician—gynecologist or other obstetric care provider managing a patient in labor. Chorioamnionitis and intraamniotic infection.


Women’s Health Care Physicians

It may be diagnosed clinically based on signs such as chorioamnoinitis fever, microbiologically based on amniotic fluid culture obtained by amniocentesis, or by histopathologic examination of the placenta and umbilical cord. The cervical mucous plug as well as the chorioamnioniyis and membranes provide a barrier to infection of the amniotic fluid and fetus.

Supportive measures include the use of antipyretics acetaminophen. Intrapartum maternal fever and neonatal outcome.

Presumptive Diagnosis of Intraamniotic Infection The diagnosis of intraamniotic infection can be established objectively by amniotic fluid culture, or gram stain, or both and biochemical analysis, but for most women at term who are in labor the diagnosis is primarily made using clinical criteria.

Definition Chorioamnionitis or intraamniotic infection is an acute inflammation of the membranes and chorion of the placenta, typically due to ascending polymicrobial bacterial infection in the setting of membrane rupture. Any updates to this document can be found on www.

Intrapartum Management of Intraamniotic Infection – ACOG

More research is needed to clarify the significance of individual microbes and their potential interactions in the pathogenesis of chorioamnionitis. Broad-spectrum antibiotics for spontaneous preterm labour: A quantitative, risk-based approach to the management of neonatal early-onset sepsis.

A randomized controlled trial. Complications of chorioamnionitis Clinical chorioamnionitis carries adverse consequences affecting both the woman and her infant Figure 2. Clinical chorioamnionitis and histologic placental inflammation. Hopkins L, Smaill F.

Findings from laboratory or bedside testing may aid in ruling in or out the diagnosis of chorioamnionitis, particularly when the clinical signs and symptoms are equivocal Table 2 [ 227 — 32 ]. J Pediatr Gastroenterol Nutr ; Chorioamnionitis leads to a 2 to 3-fold increased risk for cesarean delivery and 2 to 4-fold increase in endomyometritis, wound infection, pelvic abscess, bacteremia and postpartum hemorrhage [ 1253 — 56 ].

Preterm premature rupture of membranes: Characterization and control of intraamniotic infection in an urban teaching hospital. Women’s Health Care Physicians. In term and near-term infants it is associated with a 4-fold increase in the frequency of cerebral palsy [ 76 — 77 ].


Optimal management of clinical chorioamnionitis includes antibiotic therapy and delivery. In some settings, this approach may result in increased awareness and diagnosis of intraamniotic infection, which will affect subsequent management of newborns. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death 3.

The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Risk factors for fever in labor. Obstetric risk factors for intraamniotic infection at term have been delineated, including low parity, multiple digital examinations, use of internal uterine and fetal monitors, meconium-stained amniotic fluid, and the presence of certain genital tract pathogens eg, group B streptococcal infection and sexually transmitted infections 3, 18— The conundrum of early-onset sepsis.

Histologic chorioamnionitis captures sub-clinical as well as clinical chorioamnionitis, thus it is not surprising that overall histologic chorioamnionitis at term is up to 3 times as frequent as clinical chorioamnionitis confirmed by amniotic fluid culture [ 47 ]. Common antibiotic choices for treatment of suspected intraamniotic infection are listed in Table 1. Isolated intrapartum fever alone, whether due to infection or not, also has been associated with poor short-term and long-term neonatal outcomes 28— Confirmed intraamniotic infection is based on a positive amniotic fluid test result chorioamnlonitis stain, glucose level, aacog culture results consistent with infection or placental pathology demonstrating histologic evidence of placental infection or inflammation.

Intrapartum management of intraamniotic infection.