What are the approach considerations of obstetric management and neonatal care in the treatment of suspected chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

When acute chorioamnionitis is evident, delivery must be expedited. Upon signs of serious fetal distress, delivery must be emergent. Withholding maternal antibiotics to obtain postnatal cultures from the neonate is no longer appropriate. This strategy was once an accepted practice based on the assumption that waiting to obtain cultures from the newborn helps to determine the cause of infection. The morbidity and mortality in the mother and newborn may actually increase because of a delay in administering antibiotics.

The neonatal care provider (neonatologist, pediatrician, or family medicine physician) must decide whether the fetus was infected and whether antibiotics given before birth should be continued in the neonate. Those antibiotics may differ from those administered to the mother. The history, physical findings, and results of certain laboratory studies can assist the physician in deciding whether to continue antibiotics started during the intrapartum period. Because antibiotic chemoprophylaxis reduces the risk of GBS infection in neonates, the obstetrician must always consider beginning penicillin during the intrapartum period when a mother has defined risk factors for GBS disease. [212, 213] The neonatal care provider must judge whether the chemoprophylaxis was sufficient to prevent infection (especially in a healthy, full-term neonate) or whether the infant must continue antibiotic therapy after birth. The US Centers for Disease Control and Prevention (CDC) issued guidelines that outline the strategies for screening and treatment to prevent neonatal disease caused by GBS, the most recent guidelines were published in 2010, [170]  with an update in 2012. [171]

A retrospective study evaluating daily gentamicin for the treatment of intrapartum chorioamnionitis in 500 women found that daily gentamicin dosing using ideal body weight compared with traditional 8-hour dosing regimens was associated with a 64% lower risk of postpartum endometritis and a 5% higher chance of successful outcome. [214] These results were adjusted for maternal factors such as race, parity, advanced maternal age (>34 years), body mass index, diabetes mellitus, gestational hypertension (>140/90 mmHg), and GBS status.

Determining the appropriate procedures to prevent fetal infection in the setting of premature, prelabor, rupture of membranes is more complex. The mother who has preterm labor or premature rupture of membranes at less than 34 weeks' gestation and no clinical signs or symptoms of chorioamnionitis should receive corticosteroid therapy. [98]


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