Chorioamnionitis_Flashcards
What is Chorioamnionitis?
Chorioamnionitis is a bacterial infection that affects the amniotic fluid, membranes, and placenta around the fetus.
How common is Chorioamnionitis in pregnancies?
Chorioamnionitis can affect up to 5% of all pregnancies.
What usually causes Chorioamnionitis?
It is usually caused by an ascending bacterial infection.
What is a major risk factor for Chorioamnionitis?
A major risk factor is the preterm premature rupture of membranes.
What are the symptoms of Chorioamnionitis?
Common symptoms include fever, abdominal pain, fetal tachycardia, and malodorous amniotic fluid.
Why is Chorioamnionitis considered life-threatening?
It is life-threatening due to risks to both the mother and fetus, including sepsis and complications in delivery.
What are the main treatments for Chorioamnionitis?
The main treatments include prompt delivery of the fetus (via cesarean section if necessary) and administration of intravenous antibiotics.
summarise
Chorioamnionitis
Chorioamnionitis (which can affect up to 5% of all pregnancies) is a potentially life-threatening condition to both mother and foetus and is therefore considered a medical emergency. It is usually the result of an ascending bacterial infection of the amniotic fluid / membranes / placenta. The major risk factor in this scenario is the preterm premature rupture of membranes (however, it can still occur when the membranes are still intact) which expose the normally sterile environment of the uterus to potential pathogens. Prompt delivery of the foetus (via cesarean section if necessary) and administration of intravenous antibiotics is widely considered the mainstay of initial treatment for this condition.
A 25-year-old woman who is 35 weeks pregnant attends the Emergency Department with fever, abdominal pain and anxiety. She says that she has been waking at night with soaked bed sheets for the past few days. She has been sexually active throughout pregnancy. She reports a history of uterine fibroids.
On examination there is marked uterine tenderness and an offensive brown vaginal discharge is noted. Blood pressure is 134/93 mmHg and the maternal heart rate is 110 beats per minute. Blood results are significant for a white cell count of 18.5 * 109/l. The baseline fetal heart rate is 170 beats per minute. What is the most likely diagnosis?
Pyelonephritis
Acute herpes infection
Chorioamnionitis
Placental abruption
Fibroid red degeneration
Chorioamnionitis
The question points towards an infective process in this patient, as indicated by maternal fever, tachycardia and neutrophilia (note that the normal range is elevated during pregnancy). Chorioamnionitis is a clinical diagnosis and is suggested by uterine tenderness and foul-smelling discharge. Baseline fetal tachycardia supports the diagnosis. The aetiology in this case is likely to involve prolonged premature rupture of membranes. The mention of previous uterine fibroids is a distractor - fibroids may undergo red degeneration during pregnancy, which can present with fever, pain and vomiting, but usually in the first or second trimester.
Placental abruption has a more acute onset of abdominal pain. There are no indications of acute herpes and while pyelonephritis is definitely a differential, a history of dysuria would be expected.
