Chorioamnionitis (Complete) Flashcards
(13 cards)
Define chorioamnionitis
Intra-amniotic infection typically caused by ascending bacterial infection (e.g. group B strep, E.coli)
What is the prevalence of chorioamnionitis?
1-4% of pregnancies
What are the main causative organisms of chorioamnionitis?
Group B streptococcus
E.coli
Anaerobic bacteria (e.g. BV)
What are the main risk factors for chorioamnionitis?
Obstetric factors:
PROM
PPROM
Prolonged labour
Multiple vaginal examinations during labour
Internal monitoring devices (e.g. intrauterine pressure catheter)
Infection:
Group B streptococcis
E.coli
BV
Maternal demographic:
Nuliparity
Young maternal age
What are the main clinical features of chorioamnionitis?
Fever
Abdominal pain
Malodorous vaginal discharge
Evidence of preterm rupture of membranes (PROM)
Cervical tenderness
Maternal and foetal tachycardia
What are the main maternal complications of chorioamnionitis?
Sepsis
Post-partum haemorrhage
Post-partum infection (e.g. endometritis)
Increased risk of C-section
What are the main foetal complications of chorioamnionitis?
Neonatal sepsis
Preterm birth
Respiratory distress syndrome
Neurological complications (e.g. cerebral palsy)
Stillbirth (in severe cases)
What differentials should be considered alongside chorioamnionitis?
UTI
Placental abruption
- Bleeding and rigid uterus
Appendicitis
What investigations should be conducted in patients with suspected chorioamnionitis?
Bedside:
Basic obs: Check for fever and signs of sepsis
Pregnant abdomen examination: Check for tenderness and foetal position
Speculum examination and swabs for culture: Check for infection
- CONTRAINDICTED if known rupture of membranes
Urine dipstick + urinalysis: Check for UTI
CTG: Check for signs of foetal distress (e.g. tacchycardia)
Bloods:
Blood cultures: If sepsis suspected
FBC: Check infection
CRP: Check infection
When is speculum examination contraindicted in patients with suspected chorioamnionitis?
Contraindicted if known rupture of membranes as this can cause ascending infection
What is the management plan for patients with chorioamnionitis?
Hospital admission and delivery
Conservative:
Maternal and foetal monitoring
Medicine:
IV broad-spectrum antibiotics
- First-line: Gentamicin, ampicillin
Induction of labour
- Early delivery indicated in cases of foetal or maternal comprimise
Surgical:
C-section: Can be considered in cases where induction of labour fails and foetal distress
What antibiotics are used first-line in management of chorioamnionitis?
Gentamicin
Ampicillin
What additional antibiotics may be given in cases of C-section to cover for anaerobic microbes?
Clindamycin
Mentronidazole
