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Chorioamnionitis affects an estimated 2-4% of term deliveries and 40-70% of preterm deliveries 1.
Clinically, chorioamnionitis can present with the following maternal signs and symptoms 1,2:
- abdominal pain / uterine tenderness
- raised white blood cell count (> 15 000 cells/mm3)
- purulent or foul vaginal discharge
Chorioamnionitis most frequently occurs due to ascending bacterial infection from the lower genital tract (vagina and cervix) in the setting of prolonged rupture of membranes (PROM) 1. Other less common causes include the introduction of infection through invasive procedures such as amniocentesis and chorionic villus sampling 1,2.
Treatment and prognosis
Immediate initiation of intrapartum broad-spectrum antibiotics greatly reduces adverse maternal and fetal outcomes from chorioamnionitis 1.
Differentials that may be considered in the setting of maternal fever and/or abdominal pain include 2:
- epidural-associated fever (in women with epidural catheter for analgesia)
- neonatal sepsis 1
- increased risk of cerebral palsy 3
- 1. Czikk M, McCarthy F, Murphy K. Chorioamnionitis: From Pathogenesis to Treatment. Clin Microbiol Infect. 2011;17(9):1304-11. doi:10.1111/j.1469-0691.2011.03574.x
- 2. Tita A & Andrews W. Diagnosis and Management of Clinical Chorioamnionitis. Clin Perinatol. 2010;37(2):339-54. doi:10.1016/j.clp.2010.02.003
- 3. Ricardo Azziz. McGraw-Hill Specialty Review: Obstetrics & Gynecology: Cases, Questions, and Answers. (2006) ISBN: 9780071458207
- 4. Gantert M, Been J, Gavilanes A, Garnier Y, Zimmermann L, Kramer B. Chorioamnionitis: A Multiorgan Disease of the Fetus? J Perinatol. 2010;30(S1):S21-30. doi:10.1038/jp.2010.96
- 5. Rebecca N Baergen. Manual of Pathology of the Human Placenta. (2011) ISBN: 9781441974938