Description
Infection of the chorion, amnion, amniotic fluid, placenta, or a combination of these is referred to as intra-amniotic infection. Obstetric difficulties and issues in the foetus and newborn are more likely to occur when there is infection. Fever, uterine pain, foul-smelling amniotic fluid, purulent cervical discharge, and foetal or maternal tachycardia are all signs of the condition. The diagnosis is made using particular clinical criteria or, in the case of a subclinical illness, amniotic fluid investigation. Antipyretics, delivery, and broad-spectrum antibiotics are all included in the treatment. Intra-amniotic infection can lead to preterm PROM or preterm delivery as well as be one of their effects. 50 percent of preterm births are caused by this virus. It happens in 33% of cases of premature labor with intact membranes, 40% of cases of PROM with contractions at admission, and 75% of cases of labor starting after hospitalization for PROM.
Summary Listen
- Etiopathology of intraamniotic infection usually involves polymicrobial origins, with both aerobic and anaerobic bacteria. It often stems from an ascending infection from the vagina to the amniotic cavity, typically sterile and protected by the cervical plug. The retrograde movement of vaginal flora into the amniotic cavity can occur under certain conditions and after invasive procedures such as amniocentesis or chorionic villus sampling. Hematogenous spread due to maternal systemic infections, like Listeria monocytogenes, can also cause infection, as can direct spread from the peritoneal cavity through the fallopian tube.
- Risk factors for intraamniotic infection include premature rupture of membranes (PROM), prolonged labor, preterm labor, post-dated pregnancy, induction of labor, and sexually transmitted diseases. Maternal diabetes, Group B Streptococcus (GBS) infection, repeated vaginal examinations during labor, and the use of intrauterine or fetal monitors also increase the risk. Meconium-stained amniotic fluid and immunocompromised states further predispose to infection, as do smoking, alcohol, and drug abuse.
- Pathogenesis involves an infectious agent within the chorioamnion, leading to maternal and fetal inflammatory responses. Laboratory findings show the release of pro-inflammatory and inhibitory cytokines and chemokines. These responses can produce clinical chorioamnionitis, potentially leading to maternal and fetal sepsis, morbidity, or rarely, death. Cytokines can cause preterm premature rupture of membranes (PPROM) and cervical changes, while fetal inflammatory response syndrome can result in neonatal brain damage or multi-organ injury.
- Diagnosis involves recognizing signs and symptoms such as maternal temperature above 39°C, uterine tenderness, foul-smelling discharge, and fetal tachycardia. Laboratory tests such as a complete blood picture showing maternal leukocytosis and amniotic fluid analysis are performed. Amniotic fluid culture identifies causative organisms. Histopathological examination of the placenta and umbilical cord can reveal acute histological changes in the amniotic membrane and cord.
- Management includes intrapartum antibiotics to reduce infectious rates and maternal febrile morbidity, while ensuring proper labor progression. Antibiotics like ampicillin with gentamicin are recommended, with alternatives for penicillin-allergic patients such as cefazolin or clindamycin with gentamicin. In cases of postpartum delivery, an additional dose of the chosen regimen is often needed.
- Prevention strategies for intraamniotic infection during PROM include implementing treatment promptly to minimize morbidity and mortality for both mother and neonate. Timely maternal management and communication with neonatal caregivers are crucial. Clinical trials have demonstrated the benefits of antibiotic use, including a reduction in perinatal death and cerebral abnormalities.
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About the Speakers
Dr Aruna Reddy
Senior Gynecologist and Head OBG department Giggles Omni kukatpally Hyderabad at OMNI Hospitals
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