chorioamnionitis and post partum infections

Question 1

chorioamnionitis

Answer 1

now called intra-amniotic infection
an infection involving the amniotic fluid, placenta, fetus, fetal membranes or decidua
most intra amniotic infections are polymicrobial and caused by ascending cervicovaginal organisms

Question 2

clinical presentation of intra amniotic infection

Answer 2

often present with non-specific signs of infection
consider intra amniotic infecton in the following circumstances:
- fever 38 or more and ruptured membranes
- fever during labour, even if the membranes are in tact
- uterine tenderness
- purulent amniotic fluid

Question 3

what else should you consider in the presence of maternal fever

Answer 3

sepsis

Question 4

complications of intra amniotic infection

Answer 4

preterm labour and delivry
postpartum uterine atony with haemorrhage
maternal infections including endometritis
neonatal mrobidity and mortality related to prematurity and neonatal sepsis

Question 5

investigations

Answer 5

blood cultures if temperature >38
consider LVS, MSU
placenta culture

Question 6

risk factors for post partum endometritis

Answer 6

risk is dramatically increased following caesarean birth
also increased by:
- prolonged rupture of mambranes
- prolonged use of internal fetal monitoring
- anaemia

Question 7

endometritis is characterised by

Answer 7

lower abdominal tenderness on one or both sides of the abdomen
adnexal and parametrial tenderness elicited with bimanual examination
temperature elevation >38
some women have foul smelling lochia without other evidence of infection