Chorioamnionitis

Question 1

Diagnostic criteria for chorioamnionitis?

Answer 1

Maternal fever (>38C) and at least 2 of the following: maternal tachycardia (>120 bpm), fetal tachycardia (>160 bpm), uterine tenderness, foul-smelling discharge

WBC >15,000 is supportive but not diagnostic

Question 2

Risk factors for chorioamnionitis?

Answer 2

Prolonged rupture of membranes, multiple digital exams, placement of FSE or IUPC, prolonged labor

Question 3

Treatment of chorioamnionitis?

Answer 3

Broad spectrum abx to cover polymicrobial infection (Ureaplasma, Mycoplasma, Gardenerella, Gram negs, Bacteroides):

1) ampicillin 2g q6h and gentamicin 5 mg/kg qd
2) for penicillin infection: gentamicin 5 mg/kg qd and clindamycin 900 mg

Question 4

Chorioamnionitis ddx?

Answer 4

Pyelonephritis (would have urine findings), pneumonia, epidural fever (low-grade usually), meningitis or perispinal abscesses (rare complications of epidural anesthesia - usually not until 24-48h after delivery)

Question 5

An 18-year-old woman, gravida 1, para 0, at 41 weeks of gestation has had rupture of membranes for approximately 17 hours. She is in early labor with contractions every 5 minutes with cervical dilation at 5–6 cm. She received an epidural for pain relief 12 hours ago. Her temperature is 38.5° C (101°F). Her pulse is 124 beats per minute (bpm) and the fetal heart rate is 175 bpm with accelera- tions. She does not have any shortness of breath, dyspnea, or headaches. Her physical examination is notable for fundal tenderness. On admission, her white blood cell count was 18,000 cells/mm3 and her urinalysis had negative leukocyte esterase and nitrites. The most likely cause of her fever is:

(A) pyelonephritis
(B) chorioamnionitis
(C) pneumonia 
(D) epidural fever 
(E) meningitis

Answer 5

(B) chorioamnionitis