chorioamnionitis

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Chorioamnionitis refers to infection of the chorion and amnion during pregnancy.

Epidemiology

Chorioamnionitis affects an estimated 2-4% of term deliveries and 40-70% of preterm deliveries.

Clinical presentation

Clinically, chorionamnionitis can present with the following maternal signs and symptoms:

  • fever
  • abdominal pain / uterine tenderness
  • raised white blood cell count (> 15 000 cells/mm)
  • purulent or foul vaginal discharge
  • tachycardia

Pathology

Chorioamnionitis most frequently occurs due to an ascending bacterial infection from the lower genital tract (vagina and cervix) in the setting of prolonged rupture of membranes (PROM). Other less common causes include introduction of an infection through invasive procedures such as amniocentesis and chorionic villus sampling.

Risk factors

Treatment and prognosis

Immediate initiation of intrapartum broad spectrum antibiotics greatly reduces adverse maternal and fetal outcomes from chorioamnionitis.

Differential diagnosis

Differentials that may be considered in the setting of maternal fever and/or abdominal pain include:

  • pyelonephritis
  • appendicitis
  • pneumonia
  • epidural associated fever (in women with epidurals)
  • thrombophlebitis

Complications

  • neonatal sepsis
  • increased risk of cerebral palsy
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