What is Chorioamnionitis?

Chorioamnionitis is an infection of the fetal membranes (amnion and chorion) and amniotic fluid typically caused by bacteria ascending from the vagina into the uterus during pregnancy. It’s often associated with prolonged labor or premature rupture of membranes.

It’s a concerning condition as it can lead to complications for both the mother and the baby, such as preterm birth, sepsis, or respiratory issues for the newborn. Treatment usually involves antibiotics for the mother to prevent the spread of infection to the baby and other potential complications.

Timely medical intervention and careful monitoring are crucial to manage chorioamnionitis and reduce its impact on both the mother and the baby.

What are the signs and symptoms of chorioamnionitis?

Symptoms of chorioamnionitis vary. Some of the most common are:

Fever
Tender or painful uterus
Sweating
Vaginal discharge that has an unpleasant odor or an unusual color
The heartbeat of the mother or the fetus becomes fast

What causes chorioamnionitis in pregnancy?

Chorioamnionitis typically occurs due to bacteria entering the uterus and infecting the fetal membranes (amnion and chorion) and the amniotic fluid. The most common cause is the ascent of bacteria from the vagina into the uterus. This ascent can happen for various reasons:

Prolonged labor: When labor is prolonged, the amniotic sac may rupture for an extended period, providing an entry point for bacteria from the vaginal canal to reach the uterus.
Premature rupture of membranes (PROM): If the amniotic sac ruptures before the onset of labor, it can increase the risk of bacterial ascension, leading to chorioamnionitis.
Genital tract infections: Existing infections in the mother’s genital tract, such as bacterial vaginosis or sexually transmitted infections like chlamydia or gonorrhea, can increase the likelihood of bacterial ascent into the uterus.
Weakened immune system: A compromised immune system in the mother may be less effective at preventing bacterial infections from ascending into the uterus.

Complications

Chorioamnionitis can lead to several complications for both the mother and the baby.

Maternal complications

Sepsis: Chorioamnionitis can progress to a severe infection in the mother’s bloodstream, causing sepsis, which can be life-threatening if not treated promptly.
Postpartum infections: The risk of infections in the mother after delivery, such as endometritis (infection of the uterus lining), is increased.
Pelvic abscess: In rare cases, chorioamnionitis can lead to the formation of abscesses in the pelvic region.

Fetal and neonatal complications

Preterm birth: Chorioamnionitis is associated with an increased risk of premature labor and delivery, which can lead to complications for the baby.
Respiratory issues: Newborns born to mothers with chorioamnionitis have a higher risk of developing respiratory problems, such as pneumonia or respiratory distress syndrome.
Sepsis in the newborn: The baby can develop a bloodstream infection (sepsis) due to exposure to the infected amniotic fluid.
Long-term neurological issues: In some cases, chorioamnionitis has been linked to an increased risk of cerebral palsy or other neurological complications in babies.

Prompt diagnosis and treatment of chorioamnionitis are crucial to reduce the risk of complications for both the mother and the baby. This typically involves administering antibiotics to the mother and closely monitoring her and the baby’s condition.

What are the risk factors?

The most common risk factors for this disease are:

Premature birth
Long labor
Young maternal age (less than 21 years old)
Low socioeconomic status
First pregnancy
Membranes that have been ruptured for a long time (water is broken)
Multiple vaginal examinations during childbirth
Previous infections of the lower genital tract
Internal monitoring of the fetus or uterus

You may be more likely to develop chorioamnionitis if you have one or more risk factors.

Diagnosis and tests

It’s typically diagnosed based on a combination of clinical signs, symptoms, and sometimes lab tests. Some common indicators include:

Maternal Symptoms: Fever, often above 100.4°F (38°C), uterine tenderness, rapid heart rate, foul-smelling or cloudy amniotic fluid, and sometimes abdominal pain.
Fetal Symptoms: Elevated heart rate in the fetus, detected through monitoring.
Laboratory Tests: Blood tests to check for an elevated white blood cell count (indicating infection) and sometimes amniocentesis (sampling the amniotic fluid) to test for infection.
Imaging: Ultrasound may be used to check for uterine infection or inflammation signs.

Prompt diagnosis is crucial because untreated chorioamnionitis can lead to severe complications for both the mother and the baby, including preterm birth, sepsis, and other infections.

Treatment

Treatment for chorioamnionitis typically involves a combination of approaches to address the infection and prevent complications for the mother and the baby.

Antibiotics

Administering antibiotics is the primary treatment to combat the infection. These antibiotics are usually broad-spectrum and cover a range of potential bacteria that could cause the disease.

Delivery

In many cases, if the infection is diagnosed in a pregnant woman, the medical team might recommend delivering the baby to prevent further complications. However, the decision for immediate delivery depends on various factors, such as the gestational age of the fetus, the severity of the infection, and the mother’s condition.

Supportive Care

Additional supportive measures may be necessary, such as intravenous fluids to maintain hydration, medications to manage fever and pain, and close monitoring of the mother and baby’s condition.

Follow-up

After delivery, both the mother and the newborn may continue to receive antibiotics to ensure complete eradication of the infection.

It’s important to note that the specific treatment plan can vary based on the severity of the infection, the gestational age of the fetus, and the overall health of the mother and baby. Healthcare providers will tailor the treatment approach to ensure the best possible outcomes.

Preventing chorioamnionitis

Preventing chorioamnionitis involves minimizing the risk of infections during pregnancy. While it’s not always possible to completely prevent it, there are measures that can help reduce the chances:

Prenatal Care: Attend all prenatal appointments. Regular check-ups allow healthcare providers to monitor your health and address any potential issues promptly.
Hygiene: Practice good hygiene, including washing hands regularly and thoroughly, especially before eating and after using the restroom.
Safe Sex Practices: If engaging in sexual activity during pregnancy, practicing safe sex can reduce the risk of sexually transmitted infections that could potentially lead to chorioamnionitis.
Prompt Treatment of Infections: Seek prompt treatment for any infections, such as urinary tract infections, which can increase the risk of developing chorioamnionitis if left untreated.
Avoidance of Tobacco and Illicit Drugs: Smoking and using illicit drugs can weaken the immune system and increase the risk of infections.
Healthy Lifestyle: Maintain a healthy lifestyle with a balanced diet, regular exercise (as recommended by your healthcare provider), and adequate rest.
Prompt Reporting of Symptoms: Be vigilant about symptoms like fever, abdominal pain, unusual discharge, or any other signs of infection, and report them to your healthcare provider immediately.

While these measures can help reduce the risk, it’s essential to remember that some cases of chorioamnionitis can occur without any specific risk factors. Regular prenatal care and early intervention for any signs of infection remain crucial in managing and reducing the impact of chorioamnionitis during pregnancy.

The bottom line

Chorioamnionitis is a severe disease during pregnancy. While you may be unable to control it, you can do some things. For example, recognizing the symptoms of this disease and sharing all of your pregnancy symptoms with your ob-gyn can help significantly. Possible symptoms include maternal fever, maternal or fetal tachycardia, pelvic pain, cervical discharge, and foul-smelling amniotic fluid. Chorioamnionitis should be treated immediately with antibiotics.

Additional questions

Can a baby survive in the womb without amniotic fluid?

No, the fetus cannot survive without amniotic fluid. Amniotic fluid plays a vital role in protecting the fetus. Without it, the fetus is susceptible to infection as well as other life-threatening complications.

How long can my baby survive after the water breaks?

When a woman’s water breaks, the time a baby can survive varies based on gestational age and medical care. Babies born near full term (37-42 weeks) often lead to labor soon after, while preterm babies (before 37 weeks) might require medical intervention to delay delivery for better development. Premature babies face challenges, and survival depends on the level of prematurity and available medical support.

What is sepsis?

Sepsis is a severe and potentially life-threatening condition triggered by the body’s extreme response to an infection. When the body’s immune system overreacts to an infection, it can lead to widespread inflammation, causing changes in blood flow and organ dysfunction. If left untreated, sepsis can progress to septic shock, which is a life-threatening condition characterized by extremely low blood pressure that can lead to multiple organ failure and death.