Chorioamnionitis

Chorioamnionitis is an infection. It occurs in the membranes that surround the fetus. These membranes are called the chorion and the amnion. It is also an infection of the amniotic fluid. This fluid surrounds the fetus and protects it.

Chorioamnionitis can be a very serious condition. It requires special care from the doctor. A pregnant woman will need to deliver her baby immediately. This is for the welfare of both the mother and the baby.

Birthing Complications: Intrauterine (Uterine) Infection

© 2011 Nucleus Medical Media, Inc.

Bacterial infections usually cause this condition. Infection may begin in the mother’s genital tract. Bacteria then move up from the vagina, through the cervix, and into the fetal membranes. It then moves into the amniotic sac and its fluid. There it can then pass to the fetus. Many types of bacteria may cause this infection.

Risk Factors

These risk factors increase your chance of developing chorioamnionitis. Your doctor will assess you for risk factors:

• Young age
• Low socioeconomic status
• First child
• Multiple vaginal exams after rupture of the amniotic sac
• History of bacterial infection (eg, group B streptococcus [GBS], bacterial vaginosis)
• Premature rupture of membranes —your water breaks before you go into active labor
• Long labor
• A previous baby born before 37 weeks

Symptoms

Some symptoms include:

• Fever
• Increased heart rate in both the mother and the fetus
• Tender uterus
• Smelly discharge from the vagina
• Maternal leukocytosis (an increased number of white blood cells in the mother’s blood)
• Bacteria, white cells, and low amounts of glucose in amniotic fluid (determined by amniocentesis)

Diagnosis

The infection is diagnosed by the symptoms. Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may also include the following:

• Blood tests—to check the mother's blood cell count and other signs of infection
• Amniocentesis—a needle is inserted through the mother’s abdomen to get a sample of amniotic fluid, which is tested for bacteria, inflammatory cells, and glucose levels

The doctor will also monitor the fetal heart rate. The heart rate will increase if the mother has an infection.

Treatment

Antibiotics should begin as soon as an infection is diagnosed. The doctor may wait to give antibiotics if the mother is going to deliver the baby right away to protect the baby from the medicines.

Delivery

The baby will need to be delivered. A cesarean section (C-section) may be needed if:

• Vaginal delivery would take too long
• Mother shows signs of worsening illness
• Baby shows signs of distress

Antibiotics

• For the mother—Antibiotics will be delivered directly into the mother's veins by IV (a needle that goes into the arm). Antibiotics will be continued until the mother is without a fever for 48 hours. The medicine may include a combination of:
  • Ampicillin or penicillin
  • Gentamicin
  • Vancomycin, erythromycin, or clindamycin —if the mother is allergic to other antibiotics
• For the baby—After delivery, the baby will be monitored for infection. If needed, antibiotics will be given.

Prevention

To help reduce your chance of developing chorioamnionitis, take the following steps:

• Attend regular prenatal check-ups. Call your doctor if you have any questions or concerns.
• Get tested for GBS. This is done during your 35th-37th week.
• Take steps to prevent bacterial vaginosis. For example, practice safe sex. Do not use douches or feminine sprays.
• Tell your doctor right away if have premature rupture of the membranes (water breaking).