Candida Chorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome

Abstract

Candida chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and perinatal outcomes and discuss future management strategies. We reviewed the medical records of women with Candida chorioamnionitis at our hospital over a 10-year period (n = 9) and previous published case reports and case series. The most prevalent Candida species was C. albicans (71.3% of the all cases). The most prevalent predisposing condition was preterm premature rupture of membranes (31/123, 25.2%), followed by pregnancy with a retained intrauterine contraceptive device (26/123, 21.1%) and pregnancy after in vitro fertilization (25/123, 20.3%). Preterm labor was the most common symptom (52/123, 42.3%), and only 13% of cases involved fever. Of the infants, 27% of the singletons and 23.8% of the twins were born before 22 gestational weeks, while 60% of the singletons and 76.2% of the twins were born at 22-36 weeks. The median birth weight of the babies born after 22 weeks was 1230 g. The mortality rates of the singletons and twins born after 22 weeks of gestation in the year 2000 or later were 28.6% and 52.4%, respectively. Antenatal treatment for Candida chorioamnionitis has not been established.

Figure 1

Perinatal mortality rate of infants with Candida chorioamnionitis born after 22 weeks' gestation in the literature review. (a) Singletons born before 2000; (b) singletons born in 2000 or later; (c) twins born before 2000; (d) twins born in 2000 or later. Black bar: fetal death; gray bar: neonatal death; white bar: alive for the first 28 days of life. ^∗One infant died on day 59. ^∗∗One infant died on day 42. One twin of five twins without chorioamnionitis was excluded from analysis.