What is Chorioamnionitis?
Chorioamnionitis is an infection that can happen before, during, or after childbirth. The timing and intensity of the infection can vary, and it might become acute, subacute, or chronic. This infection is known to cause chronic lung disease in infants. If the form of chorioamnionitis is chronic, it can lead to eye disease of prematurity, very low birth weight, and hindered brain development in premature babies. Chronic chorioamnionitis is quite common.
The term “Chorioamnionitis” originated from Greek words, where “chorion” and “amnion” refer to the fetal membrane and “itis” indicates inflammation. It signifies that chorioamnionitis affects the amniotic fluid, which surrounds and protects the fetus in the womb. This infection can be discovered after childbirth or after death during a pathological examination of the placenta and umbilical cord. Specifically, in histologic chorioamnionitis, a type based on microscopic tissue examination, symptoms might not be apparent and might not be evident in the placenta or cultures.
Chorioamnionitis is most often associated with preterm labor, prolonged rupture of membranes, long labor, smoking during pregnancy, first-time pregnancy, meconium-stained fluid, numerous vaginal exams after rupture of membranes, and in women who already have known bacterial or viral infections. However, it can also occur at full term and in women without previous infections. If left untreated, chorioamnionitis can cause health issues and even death for both the mother and the newborn, particularly for early-stage pregnancies. Treatment with appropriate antibiotics reduces the risk and severity of the infection for both the mother and the baby.
What Causes Chorioamnionitis?
Chorioamnionitis is described in medical research as a condition that involves inflammation and infection in the womb. This inflammation is linked with premature birth, brain abnormalities, and eye damage. The infection can be caused by all kinds of germs, including bacteria, fungi, and viruses.
The specific type of bacteria causing chorioamnionitis can vary depending on where you live and the population. Some common bacteria found in cases of chorioamnionitis include group B streptococcus, Mycoplasma pneumoniae, Ureaplasma, Gardnerella vaginalis, Escherichia coli, and Bacteroides.
Certain fungi known as Candida have been identified as factors that can increase the risk of chorioamnionitis and can lead to premature birth and negative outcomes for the baby.
While chorioamnionitis increases the chances of in-pregnancy transmission of infections, having HIV does not necessarily increase the risk of chorioamnionitis. A study of 298 women found that the chance of getting chorioamnionitis was more tied to the number of vaginal exams they had during labor, rather than risk factors or their overall health. This applied to both groups of women involved in the study.
Risk Factors and Frequency for Chorioamnionitis
Chorioamnionitis is a condition that can happen during pregnancy, specifically affecting about 4% of full-term deliveries. However, it’s more likely in cases of preterm deliveries and when the fetal membrane ruptures too early. Symptoms of chorioamnionitis, which include fever, pain in the uterus, meconium aspiration syndrome (a newborn breathing in a mixture of meconium and amniotic fluid), and an abnormal vaginal discharge, have been found to strongly indicate the presence of this condition.
Moreover, a particular type of chorioamnionitis, known as histologic chorioamnionitis with vasculitis, is linked with a higher chance of premature rupture of membranes and preterm delivery. In fact, for deliveries occurring between 21 to 24 weeks of pregnancy, more than 94% of cases have this condition. Mothers with chorioamnionitis delivering full-term babies often experience difficulty with labor progression. Also, chorioamnionitis seen in preterm labor commonly results in preterm delivery.
- Inflamed placenta or chorioamnionitis can be seen in roughly 8% to 50% of preterm deliveries.
- In full-term pregnancies, chorioamnionitis is mostly related to labor and a history of prolonged ruptured membranes.
Signs and Symptoms of Chorioamnionitis
When a pregnant woman comes in for a check-up, the doctor needs to ask a series of questions. This includes her age, how many weeks pregnant she is, how many pregnancies she’s had in the past, and any complications during her current pregnancy. The doctor also needs to know if the protective water sac around the baby has broken, if the baby has already passed its first stool within the womb, if she has any sexually transmitted infections, urinary tract infections, and recent illness.
The doctor must also do a complete check-up of the woman, including examining the belly, vagina, and womb.
A condition called chorioamnionitis often presents itself as a fever coupled with high white blood cell count, tenderness in the uterus, abdominal pain, unusual vaginal discharge, and increased heart rate for both the mother and the baby. Doctors confirm the diagnosis of chorioamnionitis if the woman’s temperature is at least 39 C (102.2 F) or is between 38 C (100.4 F) and 39 C (102.2 F) within 30 minutes and if at least one of the clinical symptoms mentioned is present. Most women diagnosed with chorioamnionitis are either in labor or the protective water sac around the baby has already ruptured.
Testing for Chorioamnionitis
If doctors suspect an infection called chorioamnionitis, the first step is to thoroughly evaluate both the mother and the baby. Usually, a test looking at the mother’s white blood cell (WBC) count is done when there’s a suspected infection. But recent studies show that this test does not show if there is an infection or inflammation in the sac surround the fetus (the amniotic cavity) when the sac has prematurely ruptured.
It’s also important to note that the WBC count test isn’t very sensitive or precise in these cases. Additionally, taking bacterial cultures from the cervix is not recommended, as these results don’t really align with infections resulting from chorioamnionitis.
Treatment Options for Chorioamnionitis
The go-to treatment for the infection of the tissues surrounding the unborn baby (chorioamnionitis) is typically antibiotics. Most frequently, doctors use ampicillin and gentamicin. However, if you are allergic to penicillin, alternatives like clindamycin, cefazolin, or vancomycin could be used. Once the baby is delivered, there is usually an additional dose of antibiotics given if it has been a cesarean section. However, for vaginal deliveries, no extra antibiotics are given. Depending on your conditions, your doctor may decide to administer more powerful antibiotics.
What else can Chorioamnionitis be?
Abdominal discomfort and sensitivity in the womb area, when paired with a fever, could be caused by a range of issues. Women who have these symptoms while in labor need to be checked for other common illnesses like appendicitis (inflammation of an appendix), urinary tract infections, a kind of kidney infection called pyelonephritis, and pneumonia, which is a lung infection. Before landing on a final diagnosis, it’s critical that further tests and examinations are carried out in detail.
What to expect with Chorioamnionitis
Chorioamnionitis, a condition that affects pregnant women, could have negative effects on both the mother and the newborn. Endometritis, an inflammation of the uterus lining, can happen in up to a third of women who are treated for chorioamnionitis and are going through a cesarean section. The same rate of endometritis also occurs in vaginal births and cesarean births in women treated for chorioamnionitis.
Recent research has found that taking antibiotics after giving birth does not reduce the risk of developing endometritis following chorioamnionitis. However, most women with chorioamnionitis recover and won’t need more antibiotics after giving birth.
Possible Complications When Diagnosed with Chorioamnionitis
Chorioamnionitis, a medical condition that affects pregnant women, can cause several complications for both the mother and the newborn baby. For the newborn, complications may include being born prematurely, developing conditions like cerebral palsy or an eye condition called retinopathy of prematurity, having abnormal neurological function, experiencing breathing problems such as respiratory distress syndrome and bronchopulmonary dysplasia, developing an infection known as neonatal sepsis, and in some sad cases, the condition might result in neonatal death. It’s important to note, however, that in over 99% of neonatal sepsis cases tied to chorioamnionitis, cultures come back negative. Furthermore, the condition can lead to perinatal listeriosis, a serious infection, but often, the antibiotics used do not cover listeriosis associated with chorioamnionitis.
As for the mother, chorioamnionitis can also cause multiple complications. These include serious pelvic infections, subcutaneous wound infections, going into early labor, having significant bleeding after giving birth (known as postpartum hemorrhage), needing a surgical delivery, and developing a serious infection known as maternal sepsis.
Chorioamnionitis has also been found to be associated with a higher risk of mothers transmitting HIV to their babies during pregnancy.
In simplified format:
Neonatal complications include:
- Premature birth
- Cerebral palsy
- Retinopathy of prematurity
- Neurologic abnormalities
- Respiratory distress syndrome
- Bronchopulmonary dysplasia in premature babies
- Neonatal sepsis
- Neonatal death
- Perinatal listeriosis
Maternal complications include:
- Severe pelvic infections
- Subcutaneous wound infections
- Preterm delivery
- Postpartum hemorrhage
- Operative delivery
- Maternal sepsis
- Increased risk of transmitting HIV vertically during pregnancy
Preventing Chorioamnionitis
During each prenatal visit, pregnant patients should receive regular guidance. This includes being informed about the importance of reporting symptoms such as water breaking, unusual vaginal discharge, fever, and tummy pains to their pregnancy care provider. Every woman should also be educated about what could increase her risk of infections and how to recognize the signs of infections whilst pregnant.
