The most common type of infection during labor is Chorioamnionitis. It occurs in 1-4% of births in the US.
Infections during labor can happen sometimes, sometimes avoidable and sometimes not. When it happens, it can great affect labor progress, the efficiency of the contractions, and how baby tolerates labor!
Chorioamnionitis
Chorioamnionitis is an infection/inflammation of the chorion or amnion membrane in the placenta/amniotic sac. It is usually caused by a polymicrobial bacterial infection after membranes have ruptured.
it is sometimes referred to as a Intraamniotic Infection. because the infection often involves more than just the amnion and chorion membranes of the placenta. It can include the amniotic fluid, the baby, the umbilical cord, and/or the placenta in addition to the amnion and chorion.
It affects 40-70% of pre-term births, 1-13% of term births, and 12% of c-sections.
Causes of Chorioamnionitis
Usually Chorioamnionitis is caused by a combination of bacteria that is commonly found in the vagina. This can occur at any time during pregnancy.
Most commonly Chorioamnionitis occurs when the bag of water/amniotic sac is ruptured for a prolonged period before birth this increases the risk because it allows bacteria to travel to the uterus from the vagina.
There are cases where the membranes were intact but infection was passed to baby through the placenta/maternal blood flow.
If another infection is present (such as GBS, yeast, or Bacterial Vaginosis) when the water breaks this can increase the risk.
An infection being present prior to labor starting can sometimes initiate labor because the body receives signals it needs to get baby out for both parties safety.
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Risk Factors
- PROM/PPROM – water breaks before contractions have started
- Prolonged labor
- Meconium stained fluid
- >3 cervical exams
- First pregnancy
- STI or Vaginal Infection like yeast or Bacterial Vaginosis
- Internal monitoring like a FSE or IUPC
- Epidural
- GBS +
Diagnosis Criteria
Symptoms of Chorioamnionitis
- fever** This is the most important symptom
- Greater than 100.4 for more than 1 hour
- Present in 95-100% of cases
- uterine fundal tenderness (can be masked if epidural is in place)
- maternal tachycardia (>100/min)
- fetal tachycardia (>160/min)
- purulent or foul odor amniotic fluid (distinct smell!)
Lab Work
- CBC – elevated white blood count
- Testing on Amniotic Fluid
- Culture is considered the gold standard but it is not done often
Treatment for Chorioamnionitis
Administering Intravenous Antibiotics, specially a Broad-spectrum antibiotic, to treat Chorio promptly during labor is the treatment of choice. This has been proven to decrease complications for both birthing person and baby!
Antibiotics that are commonly given are Clindamycin, Gentamicin, and Ampicillin. If allergies are present Vancomycin or Cefazolin.
Given things like acetaminphen to treat the fever, and giving IV fluids can help decrease complications as well.
Expedited delivery via C-section has not been shown to improve outcomes, especially when antibiotics have been started. It is not indicated or recommended unless other factors present, such as labor arrest or worsening condition of birthing person or baby.
Complications
When Chorio is present, there are complications that can develop for both birthing person and baby.
Birthing Person
- Infections in the postpartum
- To include endometritis or abscess in wound or pelvis
- Increased risk for C-section
- Uterus is a muscle, when it is sick it cannot work as optimally and may lead to ineffective contractions that are also more painful
- Postpartum Hemorrhage
- Microbiome Disruption
- Disseminated Intravascular Coagulation *RARE*
- Adult Respiratory Distress Syndrome *RARE*
- Sepsis *RARE*
- Death *RARE*
Baby
- FIRS – Fetal inflammatory response while baby is still in the womb
- Neonatal Sepsis/Septic Shock
- Pneumonia
- Intraventricular Hemmorrhage
- Increased risk of cerebral palsy or other neurological deficits
- Due to the baby’s inflammatory response from the infection causing damage to their cerebral white matter
- Microbiome disruption
- Neonatal/Fetal Death
Prevention for Chorioamnionitis
There is not always a way to prevent it in some cases, but some ways we can prevent it:
- Decreasing cervical exams, especially when membranes are ruptured
- research supports that each cervical exam after membranes are ruptured increases your chance of developing an infection
- Prolonging/Avoiding rupturing the membranes if possible
- Treating any vagina infections promptly, especially prior to labor
- Probiotic use during pregnancy to help with your microbiome during pregnancy
- Antibiotic prophylactic used when PPROM (Premature Prelabor Rupture of Membranes) occurs
- Induction at 34weeks versus expectant management for PPROM
Chorioamnionitis is not a common infection during labor, but it is one that can lead to some long term complications for baby and short term complications for the birth person.
Best outcomes come from prompt diagnosis and treatment!