Diagnosis and Management of Intraamniotic Infection

Abstract

Intraamniotic infection (IAI) or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes, including neonatal pneumonia, respiratory distress, meningitis, sepsis, and death. Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention, cesarean birth, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and, rarely, death. Chorioamnionitis can result from an ascending infection, iatrogenic causes or transplacental passage from maternal blood-borne infections. The clinical findings of chorioamnionitis include maternal fever (≥38 °C), maternal (>100 beats per minute) and/or fetal tachycardia (>160 beats per minute), maternal leukocytosis on complete blood count (>15 000 cells/mm3), and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid. The management of chorioamnionitis mainly includes antibiotic therapy and delivery. Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach. The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible, with appropriate neonatal resuscitation available.

Placenta accreta spectrum disorder in a primigravida with angular pregnancy: a case report

“…20 The clinical findings of chorioamnionitis include maternal fever (≥38°C), maternal (>100 beats/min) and/or fetal tachycardia (>160 beats/min), maternal leukocytosis on complete blood count examination (>15,000 cells/mm³), and uterine tenderness and/or purulent and/or foulsmelling amniotic fluid. 21,22 Confirmed intraamniotic infection is based on a positive amniotic fluid test result (Gram stain, glucose level, or culture results consistent with infection) and a placental pathology demonstrating histologic evidence of placental infection or inflammation.…”

“…19,20 Other antibiotics alternatives are ceftriaxone, metronidazole, and clarithromycin; ampicillinsulbactam and azithromycin, ampicillin-sulbactam, piperacillin-tazobactam, cefotetan, cefoxitin, and ertapenem. 22 Besides, tranexamic acid is important to prevent and treat traumatic and perioperative bleeding and can reduce the consequent blood transfusion requirements. 24 The patient was primigravid; therefore, conservative management was performed to maintain her fertility.…”

The Inflammatory Milieu of Amniotic Fluid Increases with Chorio-Deciduitis Grade in Inflammation-Restricted to Choriodecidua, but Not Amnionitis, of Extra-Placental Membranes

“…This allowed us to assess the pure effect of chorio-deciduitis grade on the intensity of IAIR in the context of both early and advanced stage acute-HCA in EPM. Secondly, the intensity of IAIR was gauged with both AF MMP-8 concentration [ 62 , 63 , 64 , 65 , 66 , 67 ] and AF WBC count [ 34 , 35 , 68 , 69 , 70 , 71 ], well-known laboratory markers for IAIR in spontaneous PTB. These two markers showed consistent results adding to the credibility in current study.…”

The Fetal Inflammatory Response Syndrome (Clinical lecture)

“…1) короткий інтервал до початку пологової діяльності; 2) більш висока захворюваність новонароджених; 3) ураження багатьох органів, включаючи систему кровотворення, імунну систему, тимус, серце, надниркові залози, шкіру, легені, мозок, нирки і кишечник [4]. Надалі ознаки зазначеного патологічного стану були описані і при доношеній вагітності, при стерильному внутрішньоутробному запаленні, алоімунізації (резус-конфлікт), у новонароджених з активними аутоімунними розладами та ін.…”

“…Мікробна інвазія плода може уражувати всі органи і системи плода. Мікроорганізми при цьому здійснюють як прямий вплив, так і опосередкований -їх розпізнають Tollподібні рецептори (TLR), що надалі може індукувати продукування факторів транскрипції і спричинювати локалізовану (а згодом -системну) запальну реакцію [4,14].…”