Ectopic pregnancy: Causes, Symptoms, Diagnosis, and Complications | Medical Management of Ectopic Pregnancy

 Chorioamnionitis 

What is Chorioamnionitis?

Chorioamnionitis is the inflammation of the fetal membranes. This may be associated with prolonged or premature rupture of the membranes or a primary causes of premature labour.

Prevalence: 40% of premature deliveries.

Predominant Age: Reproductive age.

Genetics: No genetic pattern.

What are the Causes of Chorioamnionitis?

Infection by organisms that ascend from the vaginal canal, most often when the membranes have been ruptured. Studies indicate that bacteria ( especially Escherichia coli) can permeate intact chorioamnionic membranes. Infection may also occur by hematogenous, transabdominal, or transfallopian routes.

What are the Risk factors of Chorioamnionitis?

• Prolonged rupture of the membranes.
• Frequent pelvic examination.
• Bacterial or trichomonas vaginitis.
• Vaginal or cervical infection with Chlamydia trachomatis,
• Smoking
• Anaemia
• Vaginal bleeding

What are the Signs and Symptoms of Chorioamnionitis?

• Maybe asymptomatic
• Fever (>100.5F, 38°c)
• Tachycardia (maternal and fetal)
• Uterine irritability and tenderness.
• May result in premature rupture of the membrane or preterm labor.
• Maternal signs of infection ( elevated white blood count and sedimentation rate
• Purulent cervical discharge

Ectopic pregnancy: Causes, Symptoms, Diagnosis, and Complications | Medical Management of Ectopic Pregnancy

Diagnostic Approach for Chorioamnionitis

Differential Diagnosis

• Placental abruption
• Intra-abdominal infection
• Pyelonephritis
• Pneumonia
• Pulmonary embolism
• Wound infection ( episiotomy, abdominal incision following cesarian delivery or tubal ligation.)
• Breast engorgement

Associated Conditions

Endometriosis, fetal infections and oligohydramnios have been linked to clinical Chorioamnionitis. Dysfunctional labor and postpartum haemorrhage are more common. Cerebral palsy has been linked to intrauterine infection and the associated inflammatory.

Diagnostic Evaluation of Chorioamnionitis

Laboratory: White blood count and red cell sedimentation rate, Gram stain of amniotic fluid, Culture may be obtained and may be of assistance in management, but diagnosis is made on clinical grounds. Amniocentesis for culture has not been shown to improve pregnency outcome. There no clear evidence to support the use of C-reactive protein for the early diagnosis of Chorioamnionitis.

Imaging: No imaging indicated.

Special Tests: A biophysical profile of the fetus may be of assistance in planning management (if time and maternal condition permit).

Diagnostic procedures: Physical examination, cultures.

Pathological Findings

• Invasion of the chorion by mononuclear and polymorphonuclear leukocytes.

Mastitis ( Lactational)): Sings and Symptoms, Diagnostic study, Medication

Management for Chorioamnionitis

Nonpharmacological

General measure: Evaluation and antibiosis.

Specific Measures: Expedited delivery ( induction of labor, augmentation of labor).

Diet: No specific dietary changes indicated except as dictated by obstetric management.

Activity: No restriction except as dictated by obstetric management.

Drugs of Choice

Broad-spectrum antibiotic coverage based on organism suspected or detected by culture.

• Ampicillin 2g IV every 6 hours plus gentamicin 1.5 mg/kg every 8 hours
• Cefoxitin 2 g IV every 6 to 8 hours
• Ticarcillin/ clavulanate 3.1 g IV every 6 hours.
• Imipenem cilastatin 0.5 g IV every 6 hours
• Ampicillin /sulbactam 3.0 g IV every 6 hours.

Contraindications: known or suspected allergy. See individual agents for additional considerations.

Cesarean Delivery or Cesarean Section: Types, Indications, Management, Complications, Nursing intervention

Follow up

Patient Monitoring: increased need for fetal and maternal Monitoring for the effects of infection and for the associated labor.

Prevention/Avoidance: Restricted vaginal examinations in labor after rupture of the membranes.

Possible Complications: Significant sepsis may occur, in rare cases to the extent that hysterectomy may be required. There is an increased risk for dysfunctional labor and postpartum haemorrhage. If antibiotic therapy does not provide improvement in 24-48 hours, consider the possibility of abscess or septic pelvic thrombophlebitis.

Expected Outcome: With early recognition, aggressive antibiosis, and expedited delivery, the maternal response should be expected to be good. Fetal outcome is based on the gestational age at delivery.