Which agents are used in the treatment of chorioamnionitis and related neonatal infection?

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

Attitudes toward antibiotic use have changed over time (see the discussion about the sepsis calculator under Treatment: Approach Considerations. If GBS colonization of the mother is not present, and signs and symptoms of chorioamnionitis are absent, pregnant women with preterm labor or premature rupture of membranes (PROM) at more than 36 weeks' gestation should be observed for infection. Thus, prophylactic antibiotics are not given in these circumstances. Mothers at term gestation with accepted risk factors for GBS infection in their fetus should receive chemoprophylaxis. Mothers at risk of preterm birth, and in whom GBS status is unknown, receive antibiotics during latency until the GBS screening is completed. A period of observation for maternal and/or fetal infection is also required after admission, although signs and symptoms may not be evident (ie, silent disease).

A systematic review and meta-analysis of planned early birth versus expectant management for women with prelabor PROM (PPROM) prior to 37 weeks' gestation found no clinically important difference in the incidence of neonatal sepsis between women who birthed immediately and those managed expectantly. [215] Early planned birth was associated with an increase in the incidence of neonatal respiratory distress syndrome (RDS), need for ventilation, neonatal mortality, endometritis, admission to the neonatal intensive care unit, and the likelihood of birth by cesarean section; however, there was a decreased incidence of chorioamnionitis. Women randomized to early birth also had an increased risk of labor induction but a decreased length of hospital stay. [215] Babies of women randomized to early birth were more likely to be born at a lower gestational age. In women with PPROM before 37 weeks' gestation with no contraindications to continuing the pregnancy, a policy of expectant management with careful monitoring was associated with better outcomes for the mother and baby. [215, 216]

Relatively recent randomized controlled studies [217] and a meta-analysis [218] have shown that antenatal corticosteroids benefits on fetal lung maturity extend beyond 32 weeks' gestation (up to 38 weeks); this led the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to issue guidance statements about extending antenatal steroid use to selected late preterm singleton pregnancies. [219, 220] Studies have not clearly demonstrated that the use of corticosteroids increases the risk of bacterial infection in the fetus. [98]

Magnesium sulfate (MgSO4) is typically given as an obstetric tocolytic; however, its administration also appears to act differentially to modulate infection-associated inflammation in fetal membranes. A 2018 study of human fetal membrane explants indicates that MgSO4 differentially modulates lipopolysaccharide-induced fetal membrane inflammation in a time-dependent manner, partially via modulation of caspase-1 activity. [221] The investigators suggest that MgSO4 may also have utility in prevention of fetal membrane inflammation caused by polymicrobial infection.


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