What is the approach to medical treatment of suspected chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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This section addresses two topics. The first topic includes maternal interventions to treat suspected chorioamnionitis and protect the fetus from infection. The second topic includes the diagnostic approach and the appropriate treatment of neonates born to mothers with suspected chorioamnionitis.

The observation that epidural anesthesia during labor may create findings suggestive of maternal chorioamnionitis is discussed. A maternal fever that occurs when epidural anesthesia is administered during the intrapartum period has often been interpreted as chorioamnionitis. This may not be the case, and the neonate is often needlessly treated after birth.

Using ampicillin as the chemoprophylactic agent to prevent group B streptococcal (GBS) disease in the neonate is associated with other issues and should be discouraged. Ampicillin-resistant E coli infections in the mother and her infant are reported as an increasing problem, possibly due to this prophylactic practice. [210, 211]  However, the use of penicillin rather than ampicillin to prevent GBS infections of the newborn is encouraged and should be the standard of care. [212] When the mother is allergic to penicillin, she is given clindamycin if her GBS isolate is documented to be susceptible to clindamycin. Approximately 30% of GBS isolates in the United States were clindamycin resistant in 2010, and the proportion varies by country. If, however, clindamycin susceptibility testing has not been performed, vancomycin should be administered instead. [170]

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