Guidelines on Intraamniotic Infection Released by ACOG

Nicola M. Parry, DVM

August 01, 2017

New guidelines provide recommendations for the management of intrapartum intraamniotic infection. The American College of Obstetricians and Gynecologists (ACOG) published a committee opinion online July 25 and in the August issue of Obstetrics & Gynecology.

"Recognition of intrapartum intraamniotic infection and implementation of the treatment recommendations are essential steps that can effectively minimize morbidity and mortality for women and newborns," the authors write.

Intraamniotic infection, also known as chorioamnionitis, is an infection that results in inflammation of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. The infection often involves multiple pathogenic organisms, typically results from ascending migration of cervical or vaginal flora, and commonly occurs among preterm and term parturient women. However, most cases diagnosed and managed by obstetrician/gynecologists involve term patients in labor.

The infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. It can also result in long-term complications for the child, such as bronchopulmonary dysplasia and cerebral palsy.

Intraamniotic infection can lead to complications for the mother as well, such as postpartum hemorrhage, endometritis, and sepsis.

According to the committee opinion, clinicians should suspect intraamniotic infection when the mother's temperature is 39.0°C or higher or when it is between 38.0°C and 38.9°C in the presence of another clinical risk factor such as maternal leukocytosis, purulent cervical drainage, or fetal tachycardia.

ACOG recommends using intrapartum antibiotics and antipyretics when intraamniotic infection is suspected or confirmed. As intraamniotic infection is associated with dysfunctional labor, clinicians should ensure labor progresses normally in affected women. However, ACOG emphasizes that intraamniotic infection alone is not an indication for immediate delivery and is rarely, if ever, a reason for cesarean delivery.

Recommended antibiotic regimens for treatment of intraamniotic infection are ampicillin and gentamicin, cefazolin and gentamicin, or clindamycin or vancomycin and gentamicin. Antibiotic therapy should only be continued postdelivery in women with risk factors for postpartum endometritis, such as bacteremia or persistent fever; women undergoing cesarian deliveries are also more likely to have endometritis than those undergoing vaginal delivery.

Clinicians should also consider antibiotic therapy in cases of isolated maternal fever, unless a secondary cause is apparent.

The opinion also highlights the critical need for clinician communication between the maternal and neonatal healthcare teams.

"Timely maternal management together with notification of the neonatal health care providers will facilitate appropriate evaluation and empiric antibiotic treatment when indicated," the opinion concludes.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2017;130(2):e95-e101. Full text

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