- Clinical science
Chorioamnionitis is defined as an intrauterine infection of the fetal membranes and amniotic fluid caused by bacteria ascending from the vagina. The most common pathogens are Ureaplasma and Mycoplasma species. Infected women typically present with fever, purulent vaginal discharge, and malodorous amniotic fluid. The combination of maternal (> 120/min) and fetal tachycardia (> 160/min) is highly indicative of intrauterine infection, and the condition should be mananged promptly with antibiotics, supportive care, and possibly early delivery.
Chorioamnionitis, as well as colonization of the maternal genital tract with group B Streptococcus, may also be the cause of dangerous infections in the newborn. These include pneumonia, meningitis, and sepsis, and may be difficult to differentiate because symptoms in neonates are often nonspecific. Common findings include irritability, lethargy, temperature changes, dyspnea, and signs of cardiocirculatory distress (e.g., hypotension). If neonatal infection is suspected, diagnostic procedures should be initiated immediately to identify the pathogen and source of infection (e.g., blood and urine cultures). Management consists mainly of swift initiation of broad-spectrum empiric antibiotic therapy. Without proper treatment, systemic neonatal infections are associated with a high risk of complications and increased mortality rates.
Newborns are also commonly affected by localized infections such as omphalitis, an infection of the umbilical stump. The condition is most often caused by Staphylococcus aureus and group A Streptococcus and occurs 3–9 days after delivery. Clinical features include localized inflammation, swelling, and purulent discharge, which may progress to complications like sepsis and necrotizing fasciitis if not treated adequately with antibiotics (e.g., ampicillin, gentamicin).
- Infection of the amniotic fluid, fetal membranes, and placenta
- Most commonly due to ascending cervicovaginal bacteria
- Common bacteria: Ureaplasma urealyticum; (up to 50% of cases), Mycoplasma hominis; (up to 30% of cases), Gardnerella vaginalis, bacteroides; , group B Streptococcus; ,E. coli
- Risk factors
- Fetal tachycardia > 160/min in cardiotocography (∼ 40–70% of cases)
- Subclinical/silent chorioamnionitis: no clinical symptoms; may manifest as preterm labor or PROM
- Maternal blood tests:
- Urogenital secretions
- Amniotic fluid (most reliable, but rarely conducted)
- Group B Streptococcus screening: cervicovaginal and rectal swabs
- Maternal antibiotic therapy
- Swift delivery is generally indicated to minimize both maternal and fetal complications.
- Cesarean section is not generally indicated , but is often necessary because of obstetrical complications (e.g., insufficient contractions).
- For treatment of newborns, see “Neonatal infection” below.
- ≤ 72 hours after delivery
- Common causes: chorioamnionitis, bacterial colonization of the maternal genital tract (pathogen transfer to the infant)
- Common pathogens: group B Streptococcus (GBS, Streptococcus agalactiae); and E. coli; ; less common are Listeria monocytogenes (see ), Staphylococcus aureus, Enterococcus, and Haemophilus influenzae.
- Late-onset infection/sepsis
- Risk factors
- Irritability, lethargy, poor feeding
- Temperature changes (fever and hypothermia both possible)
- Cardiocirculatory: tachycardia, hypotension, poor perfusion, and delayed capillary refill > 3 sec
- Respiratory: tachypnea, dyspnea; (e.g., expiratory grunting), apnea (more common in preterm infants)
- Skin tone: jaundiced and/or bluish-gray (indicates poor perfusion)
- Neonatal meningitis
- Tachypnea with intercostal/sternal retractions and nasal flaring
- Reduced oxygen saturation with cyanosis
- Blood cultures or urine culture for suspected UTI (catheter or suprapubic aspirate)
- Blood tests
- test cerebrospinal fluid for possible meningitis :
- : : may reveal clear signs of pneumonia (e.g., segmental infiltrates) but more often nonspecific with diffuse opacities
- Supportive care (cardiopulmonary monitoring and support)
Broad-spectrum antibiotics: IV ampicillin and gentamicin
- Indications: clinical suspicion, confirmed or suspected maternal infection (e.g., chorioamnionitis)
- Adapt therapy according to antibiogram results
- Maternal GBS colonization
- Determined via culture of vaginal and rectal swabs, which are indicated between 35–37 weeks' gestation
- Anytime GBS bacteriuria occurs during pregnancy or if a previous newborn had a GBS infection
- The presence of risk factors (e.g., chorioamnionitis, fever, ↑ CRP, premature contractions, PROM)
- Maternal GBS colonization
- May cause septic shock within hours if treatment is inadequate (mortality rate up to 50%)
- The longer symptoms are present, the higher the risk of developing meningitis.
- Bacterial infection of the umbilical stump occurring 3–9 days after delivery
- Pathogens: Staphylococcus aureus, group A Streptococcus, E. coli, Klebsiella pneumoniae
- Risk factors: low birth weight, prolonged labor, maternal infection
- Periumbilical redness, tenderness, swelling, and hardening
- Purulent discharge
- Signs of systemic infection (see “Neonatal infection” above)
- Generally a clinical diagnosis, although cultures should be conducted
- Bacterial cultures: pathogen identification and antibiogram (sample of discharge)
- In systemic infection: blood and cerebrospinal fluid cultures (detection of sepsis and meningitis)
- Broad-spectrum IV antibiotics
- Surgery: complete debridement if complications arise
- Keep the navel dry (frequent diaper change)
- Observe general hygiene measures
- Marking the area of inflammation at diagnosis helps to assess improvement following treatment!