CO 712 Chorioamnionitis in Pregnancy

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Video focusing on Chorioamnionitis in pregnancy • ACOG Committee Opinion 712: https://www.acog.org/clinical/clinica... • Diagnosis: maternal fever of 39 C, or fever of 38 C with fetal tachycardia, purulent cervical discharge, maternal leukocytosis (15,000 WBC). • Treatment: ampicillin and gentamicin. • If they have a high risk PCN allergy, then you can either give them clindamycin or gentamicin. • After a cesarean section, amp/gent + clinda or flagyl is recommended. • No additional antibiotics are recommended after vaginal delivery. • Abstract (from Committee Opinion): Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Intraamniotic infection is a common condition noted among preterm and term parturients. However, most cases of intraamniotic infection detected and managed by obstetrician–gynecologists or other obstetric care providers will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. 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. Recognition of intrapartum intraamniotic infection and implementation of treatment recommendations are essential steps that effectively can minimize morbidity and mortality for women and newborns. Timely maternal management together with notification of the neonatal health care providers will facilitate appropriate evaluation and empiric antibiotic treatment when indicated. Intraamniotic infection alone is rarely, if ever, an indication for cesarean delivery. • Conclusion: Intraamniotic infection is a common condition noted among preterm and term parturients. Recognition of intrapartum intraamniotic infection and implementation of the treatment recommendations are essential steps that can effectively minimize morbidity and mortality for women and newborns. Timely maternal management together with notification of the neonatal health care providers will facilitate appropriate evaluation and empiric antibiotic treatment when indicated. Intraamniotic infection alone is rarely, if ever, an indication for cesarean delivery.

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