[Chorioamnionitis in the delivery room]

Abstract

Chorioamnionitis (CA) is defined as an infection that can affect amniotic fluid, placenta and uterus. The chorioamnionitis is present in 10-40% of cases of maternal peripartum fever and in 50% of preterm labor. Diagnosis is based on the presence of maternal fever (>38 degrees C) at least 2 of these conditions: maternal leukocytosis (> 15,000 cells/mmc), maternal tachycardia, fetal tachycardia, stained or foul smelling amniotic fluid, uterine tenderness. Obstetric risk factors include nulliparity, presence of stained amniotic fluid, the excessive duration of labor, the presence of pathogens in the genital tract (eg, Gonorrhea, GBS, EC), and the frequency of digital vaginal examinations. In suspicion of CA membranes and placenta are usually sent for histological examination performance, but the diagnosis of CS is not always confirmed by histological or microbiological exams. Early administration of broad-spectrum antibiotic therapy reduces both maternal and neonatal morbidity. The standard treatment by the administration of ampicillin and gentamicin have been shown to be safe and effective. Common maternal complications include bacteremia to septic shock, cesarean section, uterine atony with hemorrhage, pelvic abscess, maternal coagulopathy, thromboembolism and wound infections. The risk of neonatal sepsis, low seizures, low Apgar score at 5 minutes increased in the newborn. Cardiotocographic fetal monitoring should be continued during labor in cases of suspected chorioamnionitis with recourse to caesarean section as soon as signs of severe fetal distress.