What are the diagnostic considerations in chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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In the United States, civil litigation is an increasing threat to healthcare professionals. [142] This is particularly true for obstetricians and neonatologists. These caregivers have ways to avoid the experience through high-quality care and complete documentation of the clinical course. [142, 143, 144]

The initial signs and symptoms of neonatal infections may be subtle or absent; they may be followed by a rapid and devastating course. The potential for severe disability or death as a consequence of neonatal bacterial infection has resulted in the treatment of 1 infected infant of every 20 infants (or even up to 80-210 [73, 74, 75] ) who received initial therapy but had no proven disease. The evaluation to exclude sepsis is a classic example of the difficulty in differentiating infants with infection from those who are not infected. Antibiotic therapy for early-onset neonatal sepsis is a representative example of family practitioners and pediatricians practicing defensive medicine. If the diagnosis and treatment of obvious meningitis and sepsis are missed in the neonate, physicians, other healthcare professionals, and the hospital face significant medicolegal risk. [145]

The importance of chorioamnionitis takes on added medicolegal significance, because several carefully controlled studies demonstrate an association between intrauterine infection and cerebral palsy in term infants, [146, 147] as well as in preterm infants. [148, 149]  Thus, the legal profession has seen an opportunity for litigation, and attorneys have filed lawsuits that suggest earlier antibiotic therapy could have mitigated cerebral palsy. This is not the situation.

Readers are referred to a 2007 article in Clinics in Perinatology that discussed how caregivers can facilitate better understanding of an infant's hospitalization by the parents. [150]  Accurate, complete, and compassionate communication with parents about the critical condition of their preterm infant, or any infant in a neonatal intensive care unit (NICU), can help to avoid litigation. Medical record documentation of both the infant's overall disease state and (a) conversation(s) with the parents about their infant's condition are two essential elements in preventing litigation.

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