Chorioamnionitis

Chorioamnionitis has to be considered a uterine infection while the fetus r emains inside. Ascending aerobe and anaerobe bacteria are mainly responsibl e for chorioamnionitis. Amniotic inflammation occurs in 2-4% of all pregnan cies. Women with preterm deliveries and premature rupture of the membrane h ave an increased risk for developing chorioamnionitis. The published infect ion rate of the uterus cavity ranges from 10 to 50 %. In 5-10% of threatene d preterm births the intrauterine infection is detectable. Currently, simpl e test systems are available for analyses of gram-positive bacteria, leukoc yte number, cytokines and concentration of glucose in the amniotic fluid co mpleted by cultures for bacteria. The signs and symptoms of chorioamnioniti s include elevated maternal temperature (oral 37.5 degrees C; rectal 38.0 d egrees C), fetal or maternal tachycardia, and uterine contractions or tende rness. The C-reactive protein (CRP) is still the best serum parameter to pr edict amniotic infection. The two major problems of amniotic inflammation a re septic shock for the mother and involvement of the placenta and fetus. T o prevent these complications high-dose antibiotics are necessary and immed iate delivery should be considered. The local and systemic spread is due to delayed diagnosis and may present as myometritis, endomyometritis, periton itis, bacteremia, septic pneumonia or shock lung. Additionally, an infectio n of group B streptococci increases the risk for development of maternal me ningitis.