EMPHYSEMATOUS CHORIOAMNIONITIS DIAGNOSED BY ULTRASONOGRAPHY

Preterm labor, cervical cerclage (especially when performed as an emer gency procedure), and diabetes mellitus are all associated with an inc reased risk of chorioamnionitis. It might be expected that the combina tion of all 3 could lead to especially severe infection. We report suc h a case. A woman with a history of two spontaneous midtrimester abort ions had had cervical cerclage performed at 13 weeks. She was referred at 24 weeks' gestation with preterm labor, and the cervix was found t o be dilated. An emergency repeat cerclage was performed. The followin g day, ultrasonography revealed the presence of intra-amniotic gas. in fection was confirmed by the presence of a purulent cervical discharge , a neutrophilia with a left shift, and an elevated C-reactive protein level. The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed to the complications of prematurity and se psis. E. coli was isolated. In her subsequent pregnancy, severe gestat ional diabetes was diagnosed and following pregnancy, permanent diabet es mellitus was confirmed. The combination of infection, diabetes, and intact membranes may lead to a particularly severe form of chorioamni onitis, with the production of gas within the amniotic cavity. infecti on should be excluded before emergency cervical cerclage, especially i n the woman with diabetes mellitus.