CLINICAL ACTIONS: The NICHD conducted a workshop in January to review evidence, with special consideration to avoid unnecessary. The American College of Obstetricians and Gynecologists (ACOG) published a Intraamniotic infection, also known as chorioamnionitis, is an. Historically, infection of the chorion, amnion, or both was termed ” chorioamnionitis.” Although this term remains in common use, the term.

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Association of epidural-related fever and noninfectious inflammation in term labor. Management of Suspected or Confirmed Intraamniotic Infection As demonstrated in a randomized clinical trial, intrapartum antibiotic therapy for intraamniotic infection decreases the rate of neonatal bacteremia, pneumonia, and sepsis Active bacterial core surveillance ABCs: Epidural analgesia and uterine function.

Maternal morbidity from intraamniotic infection also can be significant, and may include dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. A comparison of intrapartum versus immediate postpartum treatment of intra-amniotic infection. No change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18 years.

Apantaku O, Mulik V. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death 3.

More research is needed to clarify the significance of individual microbes and their potential interactions afog the pathogenesis of chorioamnionitis.

Diagnosis and Management of Clinical Chorioamnionitis

See other articles in PMC that cite the published article. Chorioamnionitis is a common infection of pregnancy, typically occurring in the setting of prolonged membrane rupture or labor. This is a PDF file of an unedited manuscript that has been accepted for publication.

For the purposes of this Committee Opinion, the diagnosis chorioamnionitia suspected intraamniotic infection is made when the maternal temperature is greater than or equal to In clinical practice, confirmed intraamniotic infection among women in labor at term will most commonly be made after delivery, based choriozmnionitis histopathologic study of the placenta.

Diagnosis and Management of Clinical Chorioamnionitis

In addition, because of the invasive nature of the procedure, amniocentesis is not performed in the majority of cases, which occur during labor. Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.


The protective effect of maternal intrapartum antibiotic administration has been demonstrated in recent multivariate risk models of individual infant risk of neonatal sepsis 5, Anterograde infection from the peritoneum via the fallopian tubes has also been postulated [ 22 ]. Fundal tenderness is difficult to interpret in the context of the pain of labor and may be masked by analgesics including epidural or confounded by choriomanionitis pain associated with placental abruption.

Peroxide-producing lactobacilli in the birth canal may induce changes in the flora that impair the virulence of pathogenic organisms.

Proper labor progression should be ensured, given the association between intraamniotic infection and dysfunctional labor progression 3, 16, 17, The Centers for Disease Control and Prevention and the American Academy of Pediatrics provide guidelines for assessing risk of neonatal infection 7, 35— Intravenous administration of ampicillin every 6 hours and gentamicin every 8—24 hours until delivery is the typical regimen xcog 83 — 84 ].

Timely maternal management together with notification of the neonatal health care providers will facilitate appropriate evaluation and empiric antibiotic treatment when indicated. Listeria monocytogenes infection of the fetus, which presents zcog pattern of both early onset and late onset neonatal sepsis similar to GBS, is presumed to be due to a hematogenous chorioammnionitis rather than an ascending infection [ 45 ].

Management of neonates with suspected or proven early-onset bacterial sepsis. A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. On the other hand, clinical chorioamnionitis is not uniformly confirmed on pathologic evaluation.

Intrapartum Management of Intraamniotic Infection – ACOG

In a recent executive summary of proceedings acov a joint workshop sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal—Fetal Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists, a panel of hcorioamnionitis and neonatal experts recommended separating intraamniotic infection into three different categories: In Januarythe Eunice Kennedy Shriver National Institute of Child Health and Human Development invited an expert panel to a workshop to address numerous knowledge gaps and to provide evidence-based guidelines for the diagnosis and management of pregnant women with what had been commonly called chorioamnionitis and the neonates born to these women.


National Center for Biotechnology InformationU.

Silverman, MD; and Yasser Y. Edwards RK, Duff P. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Obstetric risk factors for intraamniotic infection at term have been delineated, including low parity, multiple digital examinations, use of internal uterine and fetal monitors, meconium-stained amniotic fluid, and the presence of certain genital tract pathogens eg, group B streptococcal infection and sexually transmitted infections 3, 18— Several other conditions should be considered in the differential diagnosis of chorioamnionitis.

Intraamniotic infection in low-birth-weight infants. These neonatal sepsis risk models do not affect maternal intrapartum management, but the use of maternal intrapartum data underscores the importance of communication with pediatric care providers as well as of appropriate maternal medical record documentation.

This suggests that the pathologic basis for epidural fever is chorioamnionitis [ 23 ].

AndrewsPhD, MD b. Increased intrauterine frequency of Ureaplasma urealyticum in women with preterm labor and preterm premature rupture of the membranes and subsequent cesarean delivery.

Previous intra-amniotic infection as a risk factor for subsequent peripartal uterine infections.

Am J Obstet Gynecol ; Any updates to this document can be found choroiamnionitis www. Clinical management guidelines for obstetrician-gynecologists. Generally non-specific [ 4 ]. Open in a separate window. For clinical decision-making and management, however, knowing the exact organisms involved in chorioamnionitis is not generally useful.

The use of intrapartum antibiotic treatment given either in response to maternal group B streptococcal colonization or in response to evolving signs of intraamniotic infection during labor has been associated with a nearly fold decrease in group B streptococcal-specific neonatal sepsis 6—8.

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