AKT · Obstetrics & gynaecology/Late pregnancy & labourlow yield

Chorioamnionitis

Intra-amniotic infection (often after ROM)

Overview

Infection of the chorion, amnion and amniotic fluid, usually ascending after prolonged rupture of membranes — a maternal and fetal emergency requiring delivery and antibiotics.

Recognise

Maternal fever, tachycardia; uterine tenderness
Offensive/purulent amniotic fluid; fetal tachycardia
Background of prolonged ruptured membranes/preterm ROM

Red flags

Maternal sepsis, fetal compromise — expedite delivery

Differentials & how to tell them apart

Other sepsis source (UTI, chest)no uterine tenderness/offensive liquor

Labour without infectionno fever/raised markers

Investigations

Clinical (fever + uterine tenderness + fetal tachycardia + raised inflammatory markers). FBC/CRP, cultures, CTG.

Management

IV broad-spectrum antibiotics + expedite delivery

1IV broad-spectrum antibiotics immediately and expedite delivery regardless of gestation.Gate: Do not delay delivery for steroids if the mother/fetus is compromised — infection mandates delivery
2Neonatal team at delivery; treat maternal sepsis (sepsis 6).

Broad-spectrum IV antibiotics — immediately

Expedite delivery — definitive

Key points

Prolonged rupture of membranes is the key risk. The combination of maternal fever, uterine tenderness and fetal tachycardia points to it. Delivery is part of treatment.

Monitor & prognosis

Maternal sepsis parameters, fetal CTG; neonatal sepsis.

Good with prompt antibiotics + delivery; risk of neonatal sepsis.

Source: RCOG; NICE