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. 1995;3(3):123–132. doi: 10.1155/S1064744995000457

Modern Management of Clinical Chorioamnionitis

Thomas Westover 1,2,✉, Robert A Knuppel 1
PMCID: PMC2364432  PMID: 18476034

Abstract

Clinical chorioamnionitis continues to contribute to fetal and maternal morbidity and mortality. Significant advances have been made in the last 20 years in understanding the pathophysiologic processes leading to chorioamnionitis. This review addresses the history, incidence, pathophysiology, host defenses, risk factors, diagnosis, and maternal and neonatal management of clinically evident chorioamnionitis. After a detailed review of the physiologic processes leading to clinical chorioamnionitis and sepsis, we present a modern management scheme designed to optimize perinatal outcome for both mother and fetus.

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Selected References

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  1. Ascher D. P., Becker J. A., Yoder B. A., Weisse M., Waecker N. J., Heroman W. M., Davis C., Fajardo J. E., Fischer G. W. Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis. J Perinatol. 1993 May-Jun;13(3):212–216. [PubMed] [Google Scholar]
  2. Bejar R., Curbelo V., Davis C., Gluck L. Premature labor. II. Bacterial sources of phospholipase. Obstet Gynecol. 1981 Apr;57(4):479–482. [PubMed] [Google Scholar]
  3. Duff P., Gibbs R. S. Acute intraamniotic infection due to Streptococcus pneumoniae. Obstet Gynecol. 1983 Mar;61(3 Suppl):25S–27S. [PubMed] [Google Scholar]
  4. Duff P., Sanders R., Gibbs R. S. The course of labor in term patients with chorioamnionitis. Am J Obstet Gynecol. 1983 Oct 15;147(4):391–395. doi: 10.1016/s0002-9378(16)32231-1. [DOI] [PubMed] [Google Scholar]
  5. Ford L. C., DeLange R. J., Lebherz T. B. Identification of a bactericidal factor (B-lysin) in amnionic fluid at 14 and 40 weeks' gestation. Am J Obstet Gynecol. 1977 Apr 1;127(7):788–792. doi: 10.1016/0002-9378(77)90259-9. [DOI] [PubMed] [Google Scholar]
  6. Gibbs R. S., Blanco J. D., St Clair P. J., Castaneda Y. S. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis. 1982 Jan;145(1):1–8. doi: 10.1093/infdis/145.1.1. [DOI] [PubMed] [Google Scholar]
  7. Gibbs R. S., Castillo M. S., Rodgers P. J. Management of acute chorioamnionitis. Am J Obstet Gynecol. 1980 Mar 15;136(6):709–713. doi: 10.1016/0002-9378(80)90445-7. [DOI] [PubMed] [Google Scholar]
  8. Gibbs R. S., Dinsmoor M. J., Newton E. R., Ramamurthy R. S. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection. Obstet Gynecol. 1988 Dec;72(6):823–828. doi: 10.1097/00006250-198812000-00001. [DOI] [PubMed] [Google Scholar]
  9. Gibbs R. S., Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991 May;164(5 Pt 1):1317–1326. doi: 10.1016/0002-9378(91)90707-x. [DOI] [PubMed] [Google Scholar]
  10. Gilstrap L. C., 3rd, Bawdon R. E., Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124–125. [PubMed] [Google Scholar]
  11. Gilstrap L. C., 3rd, Leveno K. J., Cox S. M., Burris J. S., Mashburn M., Rosenfeld C. R. Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. Am J Obstet Gynecol. 1988 Sep;159(3):579–583. doi: 10.1016/s0002-9378(88)80012-7. [DOI] [PubMed] [Google Scholar]
  12. Gogoi M. P. Maternal mortality from Caesarean section in infected cases. J Obstet Gynaecol Br Commonw. 1971 Apr;78(4):373–376. doi: 10.1111/j.1471-0528.1971.tb00288.x. [DOI] [PubMed] [Google Scholar]
  13. Golan A., Barnan R., Wexler S., Langer R., Bukovsky I., David M. P. Incompetence of the uterine cervix. Obstet Gynecol Surv. 1989 Feb;44(2):96–107. doi: 10.1097/00006254-198902000-00004. [DOI] [PubMed] [Google Scholar]
  14. Gravett M. G., Eschenbach D. A., Speigel-Brown C. A., Holmes K. K. Rapid diagnosis of amniotic-fluid infection by gas-liquid chromatography. N Engl J Med. 1982 Mar 25;306(12):725–728. doi: 10.1056/NEJM198203253061207. [DOI] [PubMed] [Google Scholar]
  15. Hardt N. S., Kostenbauder M., Ogburn M., Behnke M., Resnick M., Cruz A. Influence of chorioamnionitis on long-term prognosis in low birth weight infants. Obstet Gynecol. 1985 Jan;65(1):5–10. [PubMed] [Google Scholar]
  16. Harger J. H. Comparison of success and morbidity in cervical cerclage procedures. Obstet Gynecol. 1980 Nov;56(5):543–548. [PubMed] [Google Scholar]
  17. Hauth J. C., Gilstrap L. C., 3rd, Hankins G. D., Connor K. D. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol. 1985 Jul;66(1):59–62. [PubMed] [Google Scholar]
  18. Koh K. S., Chan F. H., Monfared A. H., Ledger W. J., Paul R. H. The changing perinatal and maternal outcome in chorioamnionitis. Obstet Gynecol. 1979 Jun;53(6):730–734. [PubMed] [Google Scholar]
  19. Lennon D., Lewis B., Mantell C., Becroft D., Dove B., Farmer K., Tonkin S., Yeates N., Stamp R., Mickleson K. Epidemic perinatal listeriosis. Pediatr Infect Dis. 1984 Jan-Feb;3(1):30–34. doi: 10.1097/00006454-198401000-00008. [DOI] [PubMed] [Google Scholar]
  20. Maberry M. C., Ramin S. M., Gilstrap L. C., 3rd, Leveno K. J., Dax J. S. Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection. Obstet Gynecol. 1990 Sep;76(3 Pt 1):351–354. [PubMed] [Google Scholar]
  21. McDuffie R. S., Jr, McGregor J. A., Gibbs R. S. Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcus carriage. Obstet Gynecol. 1993 Oct;82(4 Pt 1):487–489. [PubMed] [Google Scholar]
  22. Mertz K. J., Parker A. L., Halpin G. J. Pregnancy-related mortality in New Jersey, 1975 to 1989. Am J Public Health. 1992 Aug;82(8):1085–1088. doi: 10.2105/ajph.82.8.1085. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Morales W. J., Collins E. M., Angel J. L., Knuppel R. A. Short course of antibiotic therapy in treatment of postpartum endomyometritis. Am J Obstet Gynecol. 1989 Sep;161(3):568–572. doi: 10.1016/0002-9378(89)90357-8. [DOI] [PubMed] [Google Scholar]
  24. Morales W. J. The effect of chorioamnionitis on the developmental outcome of preterm infants at one year. Obstet Gynecol. 1987 Aug;70(2):183–186. [PubMed] [Google Scholar]
  25. Mueller-Heubach E., Rubinstein D. N., Schwarz S. S. Histologic chorioamnionitis and preterm delivery in different patient populations. Obstet Gynecol. 1990 Apr;75(4):622–626. [PubMed] [Google Scholar]
  26. Newton E. R., Prihoda T. J., Gibbs R. S. Logistic regression analysis of risk factors for intra-amniotic infection. Obstet Gynecol. 1989 Apr;73(4):571–575. [PubMed] [Google Scholar]
  27. Pinsky M. R., Matuschak G. M. Multiple systems organ failure: failure of host defense homeostasis. Crit Care Clin. 1989 Apr;5(2):199–220. [PubMed] [Google Scholar]
  28. RUSSELL K. P., ANDERSON G. V. The aggressive management of ruptured membranes. Am J Obstet Gynecol. 1962 Apr 1;83:930–937. doi: 10.1016/0002-9378(62)90089-3. [DOI] [PubMed] [Google Scholar]
  29. Rackow E. C., Astiz M. E. Mechanisms and management of septic shock. Crit Care Clin. 1993 Apr;9(2):219–237. [PubMed] [Google Scholar]
  30. Rhoads G. G., Jackson L. G., Schlesselman S. E., de la Cruz F. F., Desnick R. J., Golbus M. S., Ledbetter D. H., Lubs H. A., Mahoney M. J., Pergament E. The safety and efficacy of chorionic villus sampling for early prenatal diagnosis of cytogenetic abnormalities. N Engl J Med. 1989 Mar 9;320(10):609–617. doi: 10.1056/NEJM198903093201001. [DOI] [PubMed] [Google Scholar]
  31. Schuchat A., Deaver K. A., Wenger J. D., Plikaytis B. D., Mascola L., Pinner R. W., Reingold A. L., Broome C. V. Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. The Listeria Study Group. JAMA. 1992 Apr 15;267(15):2041–2045. [PubMed] [Google Scholar]
  32. Silver R. K., Gibbs R. S., Castillo M. Effect of amniotic fluid bacteria on the course of labor in nulliparous women at term. Obstet Gynecol. 1986 Nov;68(5):587–592. [PubMed] [Google Scholar]
  33. Smith L. G., Jr, Summers P. R., Miles R. W., Biswas M. K., Pernoll M. L. Gonococcal chorioamnionitis associated with sepsis: a case report. Am J Obstet Gynecol. 1989 Mar;160(3):573–574. doi: 10.1016/s0002-9378(89)80030-4. [DOI] [PubMed] [Google Scholar]
  34. Soper D. E., Mayhall C. G., Dalton H. P. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol. 1989 Sep;161(3):562–568. doi: 10.1016/0002-9378(89)90356-6. [DOI] [PubMed] [Google Scholar]
  35. Stovall T. G., Ambrose S. E., Ling F. W., Anderson G. D. Short-course antibiotic therapy for the treatment of chorioamnionitis and postpartum endomyometritis. Am J Obstet Gynecol. 1988 Aug;159(2):404–407. doi: 10.1016/s0002-9378(88)80094-2. [DOI] [PubMed] [Google Scholar]
  36. Vintzileos A. M., Campbell W. A., Nochimson D. J., Connolly M. E., Fuenfer M. M., Hoehn G. J. The fetal biophysical profile in patients with premature rupture of the membranes--an early predictor of fetal infection. Am J Obstet Gynecol. 1985 Jul 1;152(5):510–516. doi: 10.1016/0002-9378(85)90617-9. [DOI] [PubMed] [Google Scholar]
  37. Wilkins I., Mezrow G., Lynch L., Bottone E. J., Berkowitz R. L. Amnionitis and life-threatening respiratory distress after percutaneous umbilical blood sampling. Am J Obstet Gynecol. 1989 Feb;160(2):427–428. doi: 10.1016/0002-9378(89)90465-1. [DOI] [PubMed] [Google Scholar]
  38. Wiswell T. E., Stoll B. J., Tuggle J. M. Management of asymptomatic, term gestation neonates born to mothers treated with intrapartum antibiotics. Pediatr Infect Dis J. 1990 Nov;9(11):826–831. [PubMed] [Google Scholar]
  39. Yoder P. R., Gibbs R. S., Blanco J. D., Castaneda Y. S., St Clair P. J. A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term. Am J Obstet Gynecol. 1983 Mar 15;145(6):695–701. doi: 10.1016/0002-9378(83)90575-6. [DOI] [PubMed] [Google Scholar]

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