Chorioamnionitis

Maternal Infections

Chorioamnionitis is a maternal infection that affects the placenta and the membranes that surround the growing baby. A woman can get chorioamnionitis when bacteria move upward through her vagina and into her uterus. This infection can cause early labor, as well as interrupt the exchange of nutrients and gases between the mother and baby. It can also spread to the baby through the umbilical cord or during vaginal birth. Chorioamnionitis is usually benign and does not cause harm to the baby.  In rare cases where chorioamnionitis is not properly managed, it can result in lifelong disabilities in the baby such as hypoxic-ischemic encephalopathy (HIE), cerebral palsy (CP), and periventricular leukomalacia (PVL). Doctors can prevent permanent harm through precautionary measures such as providing antibiotics to the mother and delivering the baby through an early, timely C-section.

Chorioamnionitis

Causes and Risk Factors for Chorioamnionitis

Chorioamnionitis, Maternal Infection and Birth Injury

Chorioamnionitis, or intraamniotic infection, is usually caused by bacteria ascending into the uterus from the vagina or occasionally the colon. It is more likely to occur after premature rupture of membranes (PROM), which is when the amniotic sac and chorion rupture (also known as the “water breaking”) before the start of labor. Other risk factors include:


Signs and Symptoms of Chorioamnionitis

Signs and symptoms of chorioamnionitis may include the following:

  • Maternal fever (this is the most important clinical sign of the infection)
  • Diaphoresis (excessive sweating)
  • Hypotension (low blood pressure)
  • Uterine tenderness
  • Significant maternal tachycardia (heart rate > 120 beats/min.)
  • Fetal tachycardia (heart rate > 160 – 180 beats/min.)
  • Purulent or foul-smelling amniotic fluid or vaginal discharge
  • Maternal leukocytosis (high white blood cell count)

It is important to note that some women may exhibit no clear signs or symptoms of the infection.


Diagnosis of Chorioamnionitis

Chorioamnionitis may be diagnosed based on signs such as maternal fever, microbiological indications in amniotic fluid culture, or microscopic abnormalities in the umbilical cord and placenta.

A chorioamnionitis diagnosis is typically based solely on clinical signs, since access to uncontaminated amniotic fluid or placenta for culture is invasive and usually avoided. The presence of fever (temperature > 100.4) plus two other signs (uterine tenderness, maternal or fetal tachycardia, and foul/purulent amniotic fluid) is generally required for diagnosis. In addition, the presence of risk factors of chorioamnionitis, especially membrane rupture, further strengthens diagnosis.

Other diagnostic methods are listed below:

Laboratory tests for a mother with no symptoms and who is experiencing premature labor or PROM include:

  • Examination of amniotic fluid
  • Maternal GBS screening test
  • Maternal blood studies
  • Maternal urine studies

Testing of a febrile (feverish) mother with suspected chorioamnionitis includes:

  • White blood cell counts
  • C-reactive protein levels
  • Alpha 1-proteinase inhibitor complex measurement
  • Serum interleukin-6 or ferritin levels

Studies to evaluate amniotic fluid and urogenital secretions include:

  • Bacterial cultures
  • Leukocyte count
  • Gram staining
  • pH
  • Glucose concentration

Ultrasonography may be used to determine the wellbeing of the baby in the womb.


Prevention of Chorioamnionitis

Prevention of chorioamnionitis is critical. PROM (or preterm PROM, PPROM) is a major cause of chorioamnionitis; up to 70% of women who develop PROM with contractions or labor have chorioamnionitis. Although PROM can cause chorioamnionitis, it must be noted that together with preterm labor, PROM may be caused by chorioamnionitis.

The standard for prevention of chorioamnionitis is the administration of broad spectrum antibiotics, typically involving erythromycin or azithromycin, and ampicillin for 7-10 days via IV (2 days) followed by oral routes. Labor induction and delivery is associated with reduced maternal infection and need for neonatal intensive care. When there is prolonged membrane rupture (> 18 hours) at term, prophylactic antibiotics are not indicated if the mother is not colonized with GBS.  However, the Centers for Disease Control (CDC) recommends initiating GBS prophylaxis if GBS status is unknown.

Indeed, prophylactic antibiotics have been shown to be very beneficial in reducing the incidence of neonatal death, chronic lung disease, or major brain abnormalities in the baby. Antibiotics also have been shown to reduce the incidence of chorioamnionitis and neonatal sepsis (infection of the blood stream), and to prolong time-to-delivery among mothers with preterm membrane rupture who are given expectant management (waiting for spontaneous labor).


Treatment for Chorioamnionitis

Treatment for the mother and baby with chorioamnionitis includes early delivery, supportive care, and antibiotic administration.

Prompt administration of antibiotics is essential to prevent both maternal and fetal complications.  Time to delivery after implementing antibiotic therapy has been shown to not affect morbidities, in certain cases. Thus, C-section to expedite delivery is not indicated for chorioamnionitis unless there are other obstetric indications. Intravenous (IV) administration of ampicillin every 6 hours and gentamicin every 8-24 hours until delivery is the standard regimen. If C-section is performed, clindamycin every 8 hours (or metronidazole) usually is added for anaerobic coverage. Treatment also should include administration of an additional IV dose of antibiotics after delivery.

Supportive measures include the use of acetaminophen (Tylenol), which is especially important during delivery to prevent neonatal encephalopathy (brain damage).


Outcomes of Chorioamnionitis

Chorioamnionitis is common, and typically causes no harm to the mom or baby.  Occasionally, it can damage the membranes, as well as cause release of the hormone prostaglandin and cervical ripening, which may result in early labor. Additionally, the inflammation may spread to the chorionic villi, which cover the placenta and facilitate exchange of nutrients and gases between the mother and baby. This is a condition called villitis, which is usually benign but can increase the risk of fetal death.

If chorioamnionitis and/or villitis are not properly treated, it can infrequently lead to serious outcomes in the baby, including:

What is Funisitis?

Funisitis is inflammation of the umbilical cord in response to the umbilical cord becoming infected. Funisitis often results from chorioamnionitis when infection spreads from the placental membrane to the umbilical cord, causing fetal inflammatory response syndrome (FIRS). Funisitis is usually benign, but can occasionally cause the flow of oxygen and nutrients to the baby to become compromised. Funisitis can result in stillbirth.


Legal Help for ChorioamnionitisBirth Injury Attorneys | Reiter & Walsh, PC | HIE, Birth Asphyxia, Cerebral Palsy, Birth Injury Attorneys

If your child had chorioamnionitis and now has a serious condition such as hypoxic-ischemic encephalopathy or cerebral palsy, there is a possibility that they received improper medical care. You may want to consider pursuing a medical malpractice lawsuit.

At Reiter & Walsh ABC Law Centers, we are dedicated to birth injury cases (which include infection and oxygen deprivation). Our award-winning attorneys understand the complex legal issues involved with pregnancy infection and will help you to obtain the compensation to which you are entitled. To begin your free case review, please contact Reiter & Walsh ABC Law Centers in any of the following ways:

Free Case Review | Available 24/7 | No Fee Until We Win

Phone (toll-free): 888-419-2229
Press the Live Chat button on your browser
Complete Our Online Contact Form


How Do You Pronounce Chorioamnionitis?


Sources:

Related Articles & Blogs from Reiter & Walsh ABC Law Centers