Summary

Chorioamnionitis is an acute intra-amniotic infection, usually due to ascending polymicrobial bacteria, associated with prolonged rupture of membranes and labor. It presents with maternal fever, tachycardia, uterine tenderness, malodorous fluid, and fetal tachycardia. Diagnosis is clinical, and management requires prompt IV broad-spectrum antibiotics and expedited delivery to prevent severe maternal (endometritis, sepsis, DIC) and neonatal (sepsis, prematurity, death) complications

Definition

nition

• Acute infection and inflammation of the amniotic fluid, fetal membranes, and placenta.

• Most commonly due to ascending polymicrobial cervicovaginal bacteria

Etiology / Common Organisms

• Ureaplasma urealyticum (≈50%)

• Mycoplasma hominis (≈30%)

• Gardnerella vaginalis

• Bacteroides species

• Group B Streptococcus

• Escherichia coli

Risk Factors

• Prolonged labor or premature rupture of membranes (PROM)

• Pathological vaginal colonization (STIs, recurrent UTIs)

• Iatrogenic: multiple vaginal exams, invasive procedures (e.g., amniocentesis)
  

Clinical Features

• Maternal: fever >38 °C, tachycardia >120/min, uterine tenderness, pelvic pain, malodorous/purulent amniotic fluid, premature contractions, PROM

• Fetal: tachycardia >160/min

Diagnosis

• Clinical diagnosis: maternal fever + ≥1 additional sign (tachycardia, uterine tenderness, fetal tachycardia, malodorous amniotic fluid, purulent vaginal discharge)

• Supportive tests:

• Leukocytosis >15,000/µL

• ↑ CRP

• Cultures: urogenital secretions, amniotic fluid (rarely performed)

• Group B strep screening (cervicovaginal/rectal swabs)
  

Management

• Antibiotics:

• Vaginal delivery: IV ampicillin + gentamicin

• Cesarean delivery: add clindamycin (anaerobic coverage)

• Delivery:

• Prompt delivery is indicated

• Vaginal route preferred; cesarean only for obstetric indications

Complications

• Maternal: uterine atony, postpartum hemorrhage, endometritis, septic shock, DIC, venous thrombosis, pulmonary embolism, death

• Fetal/Neonatal: fetal death, prematurity, asphyxia, intraventricular hemorrhage, cerebral palsy, neonatal sepsis