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Chorioamnionitis – Causes, Symptoms and Treatment

Chorioamnionitis is a bacterial inflammation of the fetal membranes and amniotic fluid during pregnancy. It poses serious risks to both mother and baby.

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Things worth knowing about "Chorioamnionitis"

Chorioamnionitis is a bacterial inflammation of the fetal membranes and amniotic fluid during pregnancy. It poses serious risks to both mother and baby.

What is Chorioamnionitis?

Chorioamnionitis is an inflammation of the fetal membranes (chorion and amnion) and the amniotic fluid, most commonly caused by a bacterial infection. It typically occurs during pregnancy or labor and represents a serious obstetric complication that can endanger both the mother and the unborn child. It is also referred to as intrauterine infection or intra-amniotic infection (IAI).

Causes

In most cases, chorioamnionitis results from bacteria ascending from the lower genital tract and colonizing the fetal membranes. Less commonly, infection reaches the placenta through the bloodstream (hematogenous spread).

Common pathogens: Group B Streptococcus, Escherichia coli, anaerobes, Mycoplasma and Ureaplasma species
Premature rupture of membranes: Loss of the protective amniotic sac significantly increases infection risk
Prolonged labor: Extended labor duration facilitates the ascent of bacteria
Multiple vaginal examinations: Frequent internal examinations during labor increase the risk of introducing pathogens
Bacterial vaginosis: An altered vaginal microbiome raises susceptibility
Preterm birth: Preterm deliveries are more frequently associated with chorioamnionitis

Symptoms

The clinical signs of chorioamnionitis can vary. In some cases, the condition may initially be subclinical, meaning it progresses without obvious symptoms.

Maternal fever (usually above 38 degrees Celsius), often the first and most important sign
Maternal tachycardia (elevated heart rate)
Fetal tachycardia (elevated fetal heart rate detected on cardiotocography)
Uterine tenderness (pain or sensitivity upon palpation of the uterus)
Foul-smelling or cloudy amniotic fluid
Elevated blood markers: Increased white blood cell count (leukocytosis) and raised CRP levels

Diagnosis

Chorioamnionitis is primarily diagnosed clinically, based on symptoms and physical examination. Laboratory tests and additional investigations are used to support the diagnosis.

Blood tests and inflammatory markers: Elevated leukocyte count, CRP, and procalcitonin indicate an active infection
Microbiological cultures: Cervical swabs and, if necessary, amniotic fluid analysis to identify the causative organism
Cardiotocography (CTG) monitoring: Continuous monitoring of fetal heart rate for signs of fetal distress
Ultrasound: Assessment of amniotic fluid and fetal well-being
Histological examination: Definitive confirmation after delivery through microscopic analysis of the placenta and fetal membranes

Treatment

Chorioamnionitis is a medical emergency requiring prompt treatment to prevent serious complications for mother and child.

Antibiotic Therapy

The immediate administration of broad-spectrum antibiotics is the cornerstone of treatment. Commonly used regimens include ampicillin combined with gentamicin, with the addition of an agent covering anaerobes when indicated. Treatment is typically delivered intravenously.

Delivery

In addition to antibiotic therapy, timely delivery of the baby is essential. The mode of delivery -- vaginal or cesarean section -- is determined by the clinical condition of the mother and baby as well as gestational age.

Neonatal Care

Newborns of mothers with chorioamnionitis are closely monitored for signs of neonatal sepsis. Depending on the condition of the newborn, antibiotic therapy may also be required for the infant.

Complications

If left untreated, chorioamnionitis can lead to severe complications:

Maternal sepsis (bloodstream infection)
Preterm birth or stillbirth
Neonatal sepsis and meningitis
Increased risk of brain injury in the newborn (e.g., periventricular leukomalacia)
Postpartum uterine infection (endometritis)
Increased risk of postpartum hemorrhage

References

Tita, A. T. N. & Andrews, W. W. (2010). Diagnosis and Management of Clinical Chorioamnionitis. Clinics in Perinatology, 37(2), 339-354. PubMed PMID: 20569811.
World Health Organization (WHO). Recommendations for Prevention and Treatment of Maternal Peripartum Infections. Geneva: WHO, 2015.
Higgins, R. D. et al. (2016). Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis. JAMA, 316(8), 802-813. PubMed PMID: 27552815.

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