Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment
Issued Date
2024-01-01
Resource Type
ISSN
00029378
eISSN
10976868
Scopus ID
2-s2.0-85183771441
Pubmed ID
38233317
Journal Title
American Journal of Obstetrics and Gynecology
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Obstetrics and Gynecology (2024)
Suggested Citation
Jung E., Romero R., Suksai M., Gotsch F., Chaemsaithong P., Erez O., Conde-Agudelo A., Gomez-Lopez N., Berry S.M., Meyyazhagan A., Yoon B.H. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. American Journal of Obstetrics and Gynecology (2024). doi:10.1016/j.ajog.2023.02.002 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97106
Title
Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment
Author's Affiliation
Ramathibodi Hospital
Biomedical Research Institute
MSU College of Human Medicine
Inje University Paik Hospital
University of Michigan Medical School
Soroka University Medical Center
Faculty of Medicine, Prince of Songkla University
Wayne State University School of Medicine
National Institute of Child Health and Human Development (NICHD)
Università degli Studi di Perugia
Seoul National University College of Medicine
Biomedical Research Institute
MSU College of Human Medicine
Inje University Paik Hospital
University of Michigan Medical School
Soroka University Medical Center
Faculty of Medicine, Prince of Songkla University
Wayne State University School of Medicine
National Institute of Child Health and Human Development (NICHD)
Università degli Studi di Perugia
Seoul National University College of Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
Clinical chorioamnionitis, the most common infection-related diagnosis in labor and delivery units, is an antecedent of puerperal infection and neonatal sepsis. The condition is suspected when intrapartum fever is associated with two other maternal and fetal signs of local or systemic inflammation (eg, maternal tachycardia, uterine tenderness, maternal leukocytosis, malodorous vaginal discharge or amniotic fluid, and fetal tachycardia). Clinical chorioamnionitis is a syndrome caused by intraamniotic infection, sterile intraamniotic inflammation (inflammation without bacteria), or systemic maternal inflammation induced by epidural analgesia. In cases of uncertainty, a definitive diagnosis can be made by analyzing amniotic fluid with methods to detect bacteria (Gram stain, culture, or microbial nucleic acid) and inflammation (white blood cell count, glucose concentration, interleukin-6, interleukin-8, matrix metalloproteinase-8). The most common microorganisms are Ureaplasma species, and polymicrobial infections occur in 70% of cases. The fetal attack rate is low, and the rate of positive neonatal blood cultures ranges between 0.2% and 4%. Intrapartum antibiotic administration is the standard treatment to reduce neonatal sepsis. Treatment with ampicillin and gentamicin have been recommended by professional societies, although other antibiotic regimens, eg, cephalosporins, have been used. Given the importance of Ureaplasma species as a cause of intraamniotic infection, consideration needs to be given to the administration of antimicrobial agents effective against these microorganisms such as azithromycin or clarithromycin. Routine testing of neonates born to affected mothers for genital mycoplasmas could improve the detection of neonatal sepsis. Clinical chorioamnionitis is associated with decreased uterine activity, failure to progress in labor, and postpartum hemorrhage; however, clinical chorioamnionitis by itself is not an indication for cesarean delivery. Oxytocin is often administered for labor augmentation, and it is prudent to have uterotonic agents at hand to manage postpartum hemorrhage. Infants born to mothers with clinical chorioamnionitis near term are at risk for early-onset neonatal sepsis and for long-term disability such as cerebral palsy (odds ratio, 9.3; 95% confidence interval, 2.7–31). A frontier is the noninvasive assessment of amniotic fluid to diagnose intraamniotic inflammation with a transcervical amniotic fluid collector and a rapid bedside test for IL-8 for patients with ruptured membranes. This approach promises to improve diagnostic accuracy and to provide a basis for antimicrobial administration.