What are the physical findings in chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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The presence of intraamniotic amniotic fluid "sludge," a free-floating hyperechogenic material within the amniotic fluid in close proximity to the uterine cervix, reflects intraamniotic inflammation with or without microorganisms. [127]  On uterine ultrasonography, this finding has been seen in asymptomatic women at risk for preterm delivery. [12, 128]  More recent studies confirm that amniotic fluid sludge is a useful marker of microbial invasion of the amniotic cavity, histologic chorioamnionitis, and funisitis—conditions that increase the risk for preterm delivery at an extreme gestational age. [129]  Aseptic aspiration of the "sludge" may show the material to have a low glucose content, many neutrophils, and organisms such as gram-positive cocci or Candida. [130, 128]

Clinical signs and symptoms of chorioamnionitis are not always associated with placental evidence of inflammation. [66] This is particularly true if maternal fever is the sole criterion for the diagnosis.

Epidural anesthesia during the intrapartum period has been associated with fever in the mother and the neonate [131, 132] ; a primary sterile inflammatory response either in the placenta or in the epidural space (with secondary inflammation in the placenta and chorioamniotic membranes) is the most likely etiology. [67, 68, 133]  Other etiologic factors in epidural anesthesia-induced fever include nulliparity, dysfunctional labor, prolonged labor, maternal exhaustion, dehydration, and/or prolonged rupture of membranes. [134]

Because it is hard to differentiate epidural anesthesia-induced maternal fever from intraamniotic infection, maternal and/or neonatal fevers result in more evaluations for sepsis and antibiotic treatment in neonates. [135] In addition to the risk for unnecessary exposure to antibiotics, fever itself may be damaging to the newborn, especially in the setting of hypoxia-ischemia. [136]

In the setting of epidural anesthesia during labor, the following clinical course has been observed. The fetus usually has tachycardia when the mother is febrile during labor. At birth, the newborn may also have a fever (temperature >38.0ºC [100.4ºF]). If the neonate is not septic, the temperature elevation dissipates rapidly following birth, and the newborn subsequently exhibits normal behavior. Usually a temperature elevation in the neonate has returned to normal within 30-60 minutes after birth. Furthermore, these noninfected, febrile neonates have normal Apgar scores and appear remarkably well following birth. Such newborns can be observed for illness rather than undergo a septic workup and antibiotic therapy. However, clinical judgment must be based on many factors, including the intrapartum administration of broad-spectrum antibiotics to the mother.

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