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Chorioamnionitis is inflammation of the fetal membranes (amniochorionic membrane). It most commonly results from an infectious process that has ascended from the vagina up to the uterus. It is frequently associated with premature or prolonged rupture of membranes. The risk of developing chorioamnionitis increases with each vaginal exam that is performed in the final month of pregnancy, including during labor.^[3]

Background edit

The fetal membranes consist of two parts:

The outer membrane is the chorion. It is closest to the mother and physically supports the much thinner amnion.
The inner membrane is the amnion. It is in direct contact with the amniotic fluid, which surrounds the fetus.

Clinical Features edit

Risk Factors edit

Diagnosis edit

Intermediate magnification micrograph of moderate chorioamnionitis. H&E stain.

Chorioamnionitis is diagnosed clinically in the setting of:^[1]

maternal fever.
uterine tenderness in the presence of confirmed premature rupture of membranes (PROM).

Exclusions:

maternal upper respiratory infection.
maternal urinary tract infection.

Chorioamnionitis can be diagnosed from a histologic examination of the fetal membranes.

Infiltration of the chorionic plate by neutrophils is diagnostic of (mild) chorioamnionitis. More severe chorioamnionitis involves subamniotic tissue and may have fetal membrane necrosis and/or abscess formation.

Severe chorioamnionitis may be accompanied by vasculitis of the umbilical vessels^{[disambiguation needed]} (due to the fetus' inflammatory cells) and, if very severe, funisitis (inflammation of the umbilical cord's connective tissue).

Management edit

Treatment consists of:

antibiotics (amoxicillin + gentamicin + metronidazole) for the mother, and
quickly delivering the baby.

Associations edit

Chorioamnionitis is a risk factor for periventricular leukomalacia and cerebral palsy.^[2]

References edit

^ Elmar Peter Sakala, MD, MA, MPH, FACOG. Professor of GYNOB, Loma Linda University of medicine, California. Codirector of Student Clerkship. Dept of GYNOB
^ Wu YW, Colford JM (2000). "Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis". JAMA. 284 (11): 1417–24. doi:10.1001/jama.284.11.1417. PMID 10989405.

3. Excess Digital Exams Raise Risk of Chorioamnionitis, Ob.Gyn. News, August 15, 1997

4. Centers for disease control and prevention (2002) Prevention of perinatal group B Streptococcal disease: revised guidelines from CDC. MMWR 51:RR-11:1–28

External links edit

Overview at Cleveland Clinic.
Cerebral palsy inflammation link (29 November 2003) at BBC.

[1] Elmar Peter Sakala, MD, MA, MPH, FACOG. Professor of GYNOB, Loma Linda University of medicine, California. Codirector of Student Clerkship. Dept of GYNOB

[pmid10989405-2] Wu YW, Colford JM (2000). "Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis". JAMA. 284 (11): 1417–24. doi:10.1001/jama.284.11.1417. PMID 10989405.

[1]

[2]