Chorioamnionitis

Chorioamnionitis is a bacterial infection which affects the fetal outer membrane (chorion), a sac filled with fluid (amnion) and the amniotic fluid (surrounds the fetus) leading to several diseases in the both.

What is Chorioamnionitis?

It is a bacterial infection occurring before or during the labor when the bacteria infects the three layers surrounding the fetus which can develop complications like severe infection or early delivery. The name refers to the membranes which surround the fetus including the fluid-filled sac (amnion) outer layer (chorion). Approximately 2-4% of regular vaginal deliveries suffer from Chorioamnionitis which is also known as Amnionitis (infection of the Intra-amniotic sac).

Causes

This condition develops when an infection ascends the sac due to the occurrence of the bacteria in the vagina.

Anaerobic Bacteria, E.Coli, and Streptococci of group B usually cause the condition where the fluid in the amniotic sac, fetus and the placenta catch an infection.

Symptoms

The signs lack but it has various complications like:

  • Tenderness in the uterine wall
  • Rapid heartbeat
  • Fever
  • Amniotic fluid smells bad

Risk Factors

One is more likely to develop Chorioamnionitis if:

  • Low socioeconomic status
  • Below in age 21
  • The delayed period of the delivery
  • First-time mother
  • Rupturing of the membranes for longer durations
  • Premature birth
  • Uterine monitoring and internal fetal
  • Multiple vaginal examinations during the delivery
  • Sexually transmitted diseases
  • Smoking, alcohol and drug abuse
  • Infections nearby genital parts
  • Amniotic fluid with stains of Meconium
  • African-American ethnicity
  • Weak immunity

Complications

  • Bacteremia (infection in the bloodstream)
  • Need for a C-section
  • Endometritis (a uterine lining infection)
  • Clotting of blood in the pelvis and lungs
  • Excessive loss of blood at the time of delivery

3-12% of women suffering from this condition have bacterium which calls for a C-section. Almost 8% experience an infection in the wound while 1% suffer from an abscess in the pelvis (pus collection) on having a cesarean. There are rare chances of the mother’s death.

Maternal Complications

  • Preterm labor
  • C-section
  • Miscarriage or stillbirth
  • Abdominal or pelvic infections
  • Heavy postpartum bleeding
  • Endometriosis
  • Bacteria in the blood
  • Septic shock (Life-threatening blood infection)
  • Blood clotting in the pelvis and lungs
  • Pelvic abscess (Pus in the pelvis)

Complications to the Babies

  • Meningitis (spinal cord and brain infection) in 1% full-term deliveries
  • Bacterium or Pneumonia in 5-10%
  • Neonatal Sepsis (Bacterial bloodstream infection in the newborn)
  • Chronic lung disorder
  • Intrauterine fetal demise (Death of the baby in the uterus)
  • Respiratory issues
  • Cerebral palsy and brain injury

In rare instances, the complications can turn life-threatening for the premature. However, one will remain safe in getting an antibiotic treatment on time while developing the symptoms.

Diagnosis

Physical examinations can diagnose while the tests in the laboratory can confirm that diagnosis.

Amniocentesis helps in delivering early which is a prenatal test removing the minute amounts of fluid in the amniotic sac for testing. One may have it if the fluid is low in glucose whereas high in bacterias and white blood cells (WBCs).

Diagnosis In The Pathology

Here are some extra tests which detect the symptoms of Chorioamnionitis:

  • Demonstrate signals of IAI where WBC (White blood cell) count in the blood remains. A definite examination may be done due to steroid use and labor
  • Checking CRP through blood tests, SICAM1 (soluble intercellular adhesion molecule 1), Interleukin 6 and LBP (Lipopolysaccharide binding protein)
  • Checking for low sugar and bacterias through amniotic fluid testing
  • Examining the umbilical cord and placenta to check for alterations in the amniotic membrane

Treatment

Treating it early cure the fever, shorten the time of recovery and minimizes the complications and various risks. The procedure through several antibiotics likes over an IV until the delivery including some other medications like:

  • Principen (Ampicillin)
  • Penicillin (PenVK)
  • Cefoxitin
  • Clindamycin (Cleocin)
  • Gentamicin (Garamycin)
  • Tazobactam
  • Metronidazole (Flagyl)
  • Piperacillin
  • Cefotetan
  • Cefepime

The doctor will stop the treatment once the infection starts responding to it and one can see the improvements once the fever facades.

Surgical Intervention

  • In cases of dangerous conditions, instant delivery is the best option
  • Oxytocin induces the labor if it causes uterine Antony (loss in the muscle tone of the uterus)

The Doctor will Opt for a Cesarean if:

  • Longer duration of the vaginal delivery
  • Any signs of the fetal distress
  • The condition is deteriorating
    Prolonged vaginal delivery

Supportive Care for a Neonatal Sepsis

  • Is kept under needs observation under a ventilator or NICU
  • Treating the reduction of the flow of blood (Hypovolemia), the situation where the excess acid is removed (Metabolic Acidosis) and respiratory diseases
  • Managing Coagulopathy and the deficiency of the platelet (Thrombocytopenia)
  • Regulating the sugar levels in the blood (Glucose Homeostasis)

Outlook

It does not affect the fertility, and the delivery usually is standard in the future. However, some it might be risky during the preterm including the lung disease and abnormal functioning of the brain.

Remedies

Natural remedies may lack treating it entirely but strengthen the immune system to help fight the infections:

  • Raw Garlic: Take 2-4 cloves of fresh garlic, grind it and mix with water. Drink this mixture daily to treat vaginal infections.
  • Echinacea: Fights infections thereby improving the immunity
  • Astralagus:  Mix some quantity in soup or rice for enhancing the immune system
  • Probiotic Diet: Fermented foods like curd or yogurt treat the infections from the bacterias
  • Apple Cider Vinegar Bath: Add some ACV into the bathing water and bath thrice a week to keep the germs away

Prevention

One will take several efforts to prevent the disease including:

  • Screening the inflammation in the vagina (Bacterial Vaginosis)
  • Examining the infection of group B Streptococcal on reaching 35-37 weeks
  • Reducing the number of tests on the vagina during the process of the labor
  • The low checkups of the internal organs

When to Contact a Doctor?

  • If notice amniotic fluid leaking or a vaginal discharge
  • Foul smelling vaginal discharge
  • Pain in the lower abdomen
  • The urine giving out the ammonia-like color

ICD-9 and ICD-10 Codes

ICD-9 code is 762.7

ICD-10 code is O41.1230

References

https://www.healthline.com/health/pregnancy/infections-chorioamnionitis

https://www.momjunction.com/articles/chorioamnionitis-in-pregnancy_00381892/#gref

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