Chorioamnionitis#
Executive summary
Chroioaminiotis refers to inflammation and/or infection of the intrauterine structures during pregnancy
It is rare in term deliveries, but is very common in premature births
‘Chorioamnionitis (or intra-aminotic infection) is a term encompassing a broad spectrum of disease during pregnancy that is characterized by inflammation and/or infection of intrauterine structures such as the placenta, the chorion and amnion. The clinical presentation of chorioamnionitis can vary based on clinical, microbiologic, and histologic factors which interact and overlap to varying degrees. Signs and symptoms depend on whether a primary inflammatory versus an infectious process is found.’[Source]
Anecdotal mentions of “cytokine-related” outcomes are because chorioamionitis involves inflammation and/or infection, and cytokines are signalling proteins that help control inflammation in the body.
‘Chorioamnionitis is rare in full-term deliveries (more than 37 weeks gestation), affecting only around 1-4%. It is much more common in the case of premature births (less than 37 weeks gestation) where it affects 40-70% of births. Risk factors for developing chorioamnionitis during pregnancy include urinary tract infection, STIs (trichomoniasis, chlamydia, gonorrhoea, syphilis or HIV), group B strep, and bacterial vaginosis.’[source] The most common cause is ‘ascending infections into the placenta and chorion-amnion’.[Source]
‘If chorioamnionitis is suspected, a blood test or vaginal swab test will be taken. Following a diagnosis, IV antibiotics will likely be administered to treat the infection and reduce the risk of complications for mother and baby.’[source]
It is important to have a timely diagnosis and treatment of chorioamnionitis. ‘Chorioamnionitis sometimes cannot be prevented, and the condition is not always obvious at first. However, a doctor should be able to identify and address chorioamnionitis before childbirth starts. If a doctor fails to diagnose this condition and provide prompt treatment, they may be liable for medical malpractice. This means that they did not follow the procedures that a competent doctor would have followed, which resulted in a missed or delayed diagnosis and potentially untreated or inadequately treated chorioamnionitis.’[Source - Justia (legal advice)]
Outcomes#
Fetal/neonatal outcomes
Preterm neonates are at higher risk for complications than term neonates.
Immediate consequences include:
Neonatal depression at birth
Neonatal sepsis
Need for mechanical ventilation
Intraventricular hemorrhage
Fetal inflammatory response syndrome (FIRS)
Neonatal mortality.
Long-term outcomes/associations include:
Bronchopulmonary dysplasia
Periventricular leukomalacia
Cerebral palsy
Outcomes for the mother/parent
Higher risk of:
Post-partum haemorrhage
Premature birth
Postpartum infection to mother [source]
Caessarean section
Need for blood transfusion
Uterine atony
Pelvic abscesses
Postpartum endometritis
Intensive care unit (ICU) admissions.
Severe consequences include:
Puerperal sepsis, which is an important cause of global maternal mortality both in low- and high-resource settings
Definition of chroioamionitis#
‘There are a variety of definitions for chorioamnionitis set forth by international and national health authorities. In their guideline document, the World Health Organization (WHO) defines peripartum infections as “bacterial infection of the genital tract or its surrounding tissues occurring at any time between the onset of rupture of membranes or labor and the 42nd day postpartum in which two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge, abnormal smell/foul odor discharge or delay in uterine involution”. The WHO’s International Classification of Diseases ICD-10 and ICD-11 define chorioamnionitis as O41.12X “Chorioamnionitis” and as JA88.1 “Infection of the amniotic sac and membranes,” respectively. The United Kingdom’s National Institute for Health and Care Excellence (NICE) guidelines for preterm labor does not mention “chorioamnionitis” but does describe prelabor rupture of membranes as risk factor for “intrauterine infection”. The American College of Obstetricians and Gynecologists defines chorioamnionitis as “an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua”.’