IAI

Question 1

what are the three categories of fever when considering IAI?

Answer 1

• isolate maternal fever
  o 38-38.9
  o can be persistent
  o absence of IAI criteria

- suspected intra-amniotic infection
o either 1 reading of 39C and above
o or 38-38.9 with clinical criteria (1 of):
--- fetal tachycardia
--- maternal leukocytosis
--- definite purulent fluid from os

• confirmed intra-amniotic infection
  o amniotic fluid - positive gram stain, low glucose
  o placental pathology consistent with infection

Question 2

management of isolated maternal fever?

Answer 2

• abx should be considered

- consider risk factors for new born

Question 3

management of chorioamnionitis

Answer 3

• antibiotics:
  ideal-
  ampicillin 2 g IV q 6hr
  gentamycin 2 gm/kg/IV load followed by 1.5 mg/kg q8hr OR 5 mg/kg IV q24hr

if mild allergy to PCN
Ancef 2 g IV q8hr + gent

if severe allergy
Clinda 900 mg IV q8hr or Vanc 1 g IV q8hr
Gent as above

Alternative regimens:
Unasyn
Zosyn
Ertapenem
Cefotetan 
Cefoxitin

antipyretics

Question 4

c-section management with IAI?

Answer 4

amp + gent + clinda
continue clinda or flagyl x 1 dose after delivery
if other regimens no need for continuation

Question 5

maternal risks of IAI

Answer 5

endomyometritis, PPH, sepsis, ARDS, death, prolonged labor

Question 6

fetal risks

Answer 6

meningitis, PNA, sepsis, cerebral palsy (OR ~ 2)