Chorioamnionitis
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Infection of the chorionic and amniotic membranes/fluid before delivery.
Risk Factors
- Prolonged rupture of membranes
- Prolonged labour
- Untreated STI
Clinical features
- History of vaginal draining of liquor
- Fever >37.8°C
- Maternal tachycardia
- Foetal tachycardia
- Uterine tenderness
- Foul-smelling or purulent vaginal discharge
- Acute complications: postpartum haemorrhage, puerperal sepsis, renal failure
- Chronic complications: infertility due to salpingitis, and/ or uterine sinechie
Investigations
- RDT or BS to rule out Malaria
- Urinalysis to rule out UTI
- Swab (vaginal discharge) for gram stain
Management
Care for mother and neonate includes early delivery and antibiotic administration. The risk of neonatal sepsis is increased.
Treatment
- Start antibiotics and refer to hospital
- Ampicillin 2 g IV every 6 hours
- Plus gentamicin 5 mg/kg IV every 24 hours
For penicillin allergic patients, give
- Clindamycin 300-600 mg IV 12 hourly
If patient delivers vaginally
- Continue parenteral antibiotics until woman is afebrile for 48 hours and no foul-smelling discharge
- If the mother comes back with complications, refer for further care
If the woman has a Caesarean section
- Continue the above antibiotics, and add metronidazole 500 mg IV every 8 hours
- Continue until 48 hours after fever has gone
Newborn
- Examine the neonate for suspected sepsis before discharge
- If newborn sepsis is suspected manage as in septicaemia
- Advise the mother on how to recognize danger signs