Pregnancy is the archetypal hotbed of health problems, infections, and physiological upheaval. Your delicate state and weakened immunity can make you susceptible to several conditions, and Chorioamnionitis is just one of them. So, if you have been diagnosed with the condition, or are simply looking for some information about the infection, read our post here.
What Is Chorioamnionitis In Pregnancy?
Chorioamnionitis, also called intraamniotic infection is an inflammation the chorion and the amnion –the membranes surrounding the fetus. The condition is a bacterial infection that affects the amniotic fluid, in which the fetus floats.
- An ascending polymicrobial bacterial infection ruptures the surrounding membranes and leads to the infection. However, the infection can also occur in pregnant women whose membranes are intact . In some rare cases, you will notice the spread of hematogeneous implicated in chorioamnionitis, like in the case of Listeria monocytogenes.
- In the case of clinical intraamniotic infection or chorioamnionitis, there will be visible clinical signs. There are many similarities between the clinical and histological chorioamnionitis. Based on pathologic findings, histological chorioamnionitis is a common diagnosis upon microscopic examination of the placenta that encompasses clinical and sub-clinical chorioamnionitis.
- Chorioamnionitis is a common pregnancy complication, which can lead to significant perinatal, maternal and other long-term outcomes that can affect your health adversely. Sepsis and postpartum infections are the main maternal adversities. In infants, premature birth, chronic lung disease, stillbirth, brain injury that could cause cerebral palsy, other neurodevelopment disabilities and neonatal sepsis are some of the effects of the infection.
- Modern research has enabled doctors to understand how this preterm delivery and intraamniotic infections are linked. It has also simplified the morbidities of preterm and term infants. The ongoing clinical research is aimed at identifying better means of testing, diagnosing, treating and preventing chorioamnionitis during pregnancy. This way, its extreme impact on the mother and fetus is reduced.
The ultimate definition of chorioamnionitis depends upon the main diagnostic criteria:
- Histopathologic Criteria: Infection or inflammation identified based on microscopic examination of the placenta or chorioamnionic specimens.
- Clinical Criteria: When typical clinical findings are present.
- Microbiological: Culture of microbes from amniotic fluid or chorioamnionitis.
[ Read: Sepsis In Pregnancy ]
Causes Of Chorioamnionitis In Pregnancy:
As we talk about above, bacteria that infect a pregnant woman’s urogenital tract typically cause chorioamnionitis. The infection can begin just about anywhere in the lower region of the body, like the rectum, anus or vagina. From there it moves up to where the fetus is in the uterus. The condition usually occurs during the second and third trimesters of pregnancy. However, this infection can occur during the first trimester, as well, cause life-threatening complications for the mother and fetus.
Bacteria such as Group B streptococci, E. coli and various kinds of anaerobic bacteria can cause chorioamnionitis .
- The bacteria can infect the uterus where there are premature ruptures in the membranes.
- The most common cause of intraamniotic infection is prolonged labor. Since the vagina and uterus are exposed to each other, the bacteria present in the vagina can travel up and into the uterus and cause this infection.
- Vaginal exams during the last month of pregnancy can result in a woman contracting chorioamnionitis.
[ Read: E Coli Infection During Pregnancy ]
Risk Factors For Chorioamnionitis:
There are other risk factors for contracting chorioamnionitis and these factors make the woman more susceptible. These risk factors include:
- Maternal age is less than 21 years of age
- First pregnancy of the mother
- If the membranes (chorion and amnion) surrounding the fetus rupture for an extended period of time
- Too many vaginal examinations during labor if the woman has ruptured membranes
- Internal monitoring of the uterus and fetus
- Already existing infections in the lower genital tract. These infections include group B strep infection and bacterial vaginosis
- Reduced function of the immune system of the mother or fetus
The more risk factors a woman has, the higher the chances of her developing chorioamnionitis.
[ Read: Group B Strep In Pregnancy ]
Symptoms Of Chorioamnionitis In Pregnancy:
Typically, chorioamnionitis does not have any symptoms, and this makes it difficult to diagnose the infection until the pregnant woman goes for her monthly OB/GYN checkup or notices the amniotic fluid leaking. However, as it is an infection, a severe one, it causes symptoms at some point that make it easier for the woman to approach her physician.
Some of the symptoms of chorioamnionitis include the following:
- High fever of more than 104 degrees F
- Maternal tachycardia, also known as rapid heartbeat
- Fetal tachycardia
- A foul-smelling discharge from the vagina
- Uterus is painful and tender to touch
- Profuse perspiration
- WBC (leukocyte) count is more than 15,000 to 18,000
Sometimes, the membranes may not rupture completely, but still the mother can develop chorioamnionitis. Under such circumstances, the doctor will suggest performing an amniocentesis, which involves removing the amniotic fluid and testing it for an infection.
It is important to remember the symptoms mentioned herein can also occur due to other health problems during pregnancy. Furthermore, some women do not exhibit any symptoms of chorioamnionitis and the infection or problem is revealed when these women visit their OB/GYN for a routine pregnancy checkup.
[ Read: Leaking Amniotic Fluid During Pregnancy ]
Diagnosing Chorioamnionitis In Pregnancy:
Doctors use a number of broad and precise diagnostic tests to diagnose chorioamnionitis. Usually, it is a combination of different tests that ensure accurate diagnosis. The diagnostic tests used are:
- Doctors use the symptoms of chorioamnionitis as a basis to make a diagnosis. If the woman has any of the symptoms, doctors immediately suspect chorioamnionitis and will perform a thorough physical examination to make a concrete diagnosis. The treatment begins immediately in such cases.
- Usually, when you have the symptoms and have reached the full term of your pregnancy, the doctor will not perform any diagnostic test. However, the doctor will perform a fetal ultrasound to monitor the health of the fetus. Right after you have the baby, he or she will be examined and closely monitored for the infection.
- Sometimes, the membranes may not rupture completely, but still the mother can develop chorioamnionitis. Under such circumstances, the doctor will suggest performing an amniocentesis, which involves removing the amniotic fluid and testing it for infection, and blood tests. The same holds true for women who go into premature labor. Along with the presence of bacteria in the amniotic fluid and low blood sugar levels, the doctor confirms the diagnosis – chorioamnionitis.
- If blood tests show high levels of C-reactive protein, interleukin 6 and lipopolysaccharide binding protein, it is a sign the woman is at a high risk of developing chorioamnionitis. So if your doctor uses these levels as a way to diagnose the infection, they will be on the right track.
- Histology of the umbilical cord and placenta also can be used to diagnose chorioamnionitis. The histology shows acute changes in the chorion of the placenta and amnionic membrane. This leads the doctor to conclusively diagnose chorioamnionitis. Usually, experts recommend performing a placental histologic test even if amniocentesis comes back negative.
[ Read: Blood Test During Pregnancy ]
Complications Due To Chorioamnionitis:
Chorioamnionitis can result in complications in the mother, fetus and the newborn baby. These complications can range from serious to life-threatening. Complications are more common when the infection is severe.
Complications For The Mother:
Some of the complications chorioamnionitis can cause in the woman include:
- Premature delivery
- Heavy bleeding after delivery
- Infection in the abdomen or pelvis
- Clotting of blood in the pelvic region and lungs
- Endometritis 
- Bacteremia 
- Sepsis 
In rare occasions, chorioamnionitis can result in the formation of an abscess in the pelvic region. This requires immediate treatment, as it can affect the fertility of the woman and prevent her from having children in the future.
[ Read: Pregnancy Complications ]
Complications For The Fetus and Newborn Baby:
This bacterial infection can result in hordes of problems in the unborn baby as well as the newborn baby if the mother has it. Some of the complications include:
- Meningitis, which is infection of the lining of the brain and spinal cord
- Respiratory distress and problems
- Brain injury
- Cerebral palsy
- Chronic lung disease
- Death of the fetus inside the womb (stillbirth)
- Death of the premature infant on account of respiratory distress and bleeding in the brain
If the infection is severe, it can result in conditions known as funisitis, which is inflammation of the connective tissue in the umbilical cord, and vasculitis, wherein inflammatory cells from the developing baby adversely affect the blood vessels in the umbilical cord.
Complications in the fetus and newborn baby are life-threatening and can also result in neurological disorders in the baby.
[ Read: How To Avoid Stillbirth ]
Treating Chorioamnionitis In Pregnancy:
Thankfully, there is no dearth of options for chorioamnionitis treatment in pregnancy. However, the treatment protocol depends on the severity of the infection, the trimester of the pregnancy and the woman’s medical history. The overall health of the woman also is taken into consideration before deciding on the right course of treatment.
Nonetheless, it is important to get treated early for the infection. It helps bring down the fever, shorten the duration of hospitalization and also minimizes the risks of the baby getting the infection or causing chorioamnionitis-related complications in mother and fetus.
Usually, chorioamnionitis is treated using the following treatment protocols:
- Here, antibiotics that are safe for the woman and growing fetus are used to treat chorioamnionitis. These antibiotics include gentamicin, metronidazole and amoxicillin.
- Doctors use a combination of antibiotics to ensure optimal results. The antibiotics target group B streptococci and E.coli bacteria. In case you are allergic to penicillin, the doctor will use an alternative antibiotic – clindamycin. Sometimes, broad-spectrum antibiotics, like cefoxitin, cefepime, piperacillin-tazobactam and cefotetan, are used to treat chorioamnionitis. Choosing the right antibiotic is left to the discretion of the doctor, as the physician also has to take into account toxicity these medications can cause.
- You receive the antibiotics intravenously until you deliver or you are fever- and symptom-free for 24 hours. This is an in-hospital treatment, and once you have no symptoms of the infection, you are allowed to go.
[ Read: Safe Antibiotics During Pregnancy ]
- This medication helps to bring down the fever and minimize the pain that the infection causes. Do not take any other medication for your fever without consulting your doctor.
[ Read: Acetaminophen During Pregnancy ]
3. Immediate Delivery:
If the mother has severe chorioamnionitis, the doctor suggests immediate delivery. This is usually an option for women, who have reached the full term of their pregnancy. Pre-term delivery is also an option when the infection is severe.
Doctors induce labor with the help of oxytocin in cases where the uterine muscles have lost their tone. A C-section could be the need of the hour if:
- Vaginal delivery is prolonged
- Mother’s condition is failing
- The fetus develops signs of distress
Once your baby is delivered, doctors monitor him for signs of infection. If the baby has chorioamnionitis, doctors typically treat him.
After you have been treated for chorioamnionitis and discharged from the hospital, you will need to visit the doctor for follow-up checkups for the next two weeks to ensure you are completely infection-free and your baby is growing healthily with no signs of complications or distress. It is important you keep to the follow-up diligently to prevent relapse or complications for yourself and your fetus.
Herbal Remedies For Chorioamnionitis In Pregnancy:
It is important to realize chorioamnionitis is a serious infection and should be treated using the medication prescribed by a qualified and certified physician. Hence, herbal remedies are not recommended. However, you can give your immune system a boost with herbs that are considered safe for use during pregnancy. This will help your body fight the infection and ensure the antibiotics used for treating your infection give quicker results.
Here are some immune boosting herbs that are safe during pregnancy. But make sure you run them through your doctor before taking the herbal remedies. This is to prevent contraindication with the medication you are taking for chorioamnionitis.
This herbal supplement is considered safe for pregnant women. It boosts immune function, and evidence shows it does result in health problems or birth defects . However, since there is no concrete evidence to substantiate these claims, make sure you take this herb under the supervision of your OB/GYN.
This herb is ubiquitously used in traditional Chinese medicine to boost immunity. Practitioners of traditional Chinese medicine routinely recommend astragalus for pregnant women. However, you should note there is no scientific study to understand the safety of this herb during pregnancy. This said the U.S. National Institutes of Health says there are no safety concerns with the use of the herb during pregnancy . But always take this herbal supplement under medical supervision.
Besides alleviating nausea and morning sickness, ginger also is regarded as an immune booster. It is replete in antioxidant, a good digestive aid and also has anti-inflammatory properties . Make sure you take the go ahead from your OB/GYN before taking ginger to boost your immune system to fight chorioamnionitis during pregnancy.
Preventing Chorioamnionitis In Pregnancy:
Your OB/GYN will take all measures to ensure you do not develop chorioamnionitis from the onset of your pregnancy. This condition is quite serious and has the potential to cause major complications in the mother and fetus. Hence, physicians make every effort to ensure pregnant women do not get the infection.
Doctors use several methods to screen and prevent chorioamnionitis. Some of these measures include the following:
- Screening for Bacterial Vaginosis: If you are at a higher risk of having a pre-term delivery, the doctor will screen you for bacterial vaginosis in the latter part of your second trimester. If the test is positive, you will be treated with antibiotics right away to prevent the infection from developing or worsening.
- Screening for Group B Streptococci Infections: When you are 35 to 37 weeks pregnant, the obstetrician will test you for group B strep infection. If you test positive, you will get antibiotic intravenously during labor to reduce chances of infection and/or passing on the infection to your baby.
- Reducing Number of Vaginal Examinations: If you go into labor, the doctor will refrain from rupturing the membranes unless there is a need for it. Hence, doctors do not perform too many vaginal examinations during labor. Internal monitoring of the fetus is used as an option only if there is a compelling reason, such as fetus distress or tachycardia.
[ Read: Bacterial Infections During Pregnancy ]
How Chorioamnionitis Affects Labor And Delivery:
Chorioamnionitis is a serious infection and hence, shouldn’t be taken lightly. The infection can protract your labor, making it necessary for the doctor to decide on a C-section to deliver the baby.
- A vast majority of women who have the infection requires oxytocin to get their uterus to contract. Several more require C-section when vaginal delivery is prolonged. During labor, your OB/GYN will closely monitor your contractions to ensure they are occurring properly. Should a doubt arise, the doctor may recommend oxytocin or cesarean delivery.
- The infection is stressful for the fetus and hence, doctors monitor fetal heart rate carefully during labor. In a majority of cases, the fetal heart rate increases and to prevent fetal distress, the doctor needs to act quickly and swiftly.
- The fetus also may suffer from oxygen deficiency during labor. So, the scalp blood sample of the baby is tested for acid-base balance to ensure the baby is getting sufficient amount of oxygen during labor.
- Babies delivered to mothers who have the infection have a likelihood of developing pneumonia or bacteremia.
- A small number of babies, both full-term and pre-term, can develop meningitis due to maternal infection.
- Some babies can succumb to the infection or due to complications, such as brain hemorrhage or respiratory distress.
The prognosis of chorioamnionitis depends on how severe the infection is and when it was diagnosed during the pregnancy. It has been observed women who contract the infection in the later stages of their pregnancy are less likely to develop complications compared to women who develop it early in their pregnancy. Generally speaking, prognosis for chorioamnionitis is positive, as there are treatments available to ensure maternal and fetal health.
- Long-term effects of chorioamnionitis are rare and prognosis is good for the woman
- Women, who had chorioamnionitis during their first pregnancy, are more likely to get the infection in their subsequent pregnancy. This clearly shows there is a genetic disposition among such women for uterine infections
- Developing chorioamnionitis usually does not affect your fertility and you can easily have more children in the future, as long as you are properly treated by a qualified health care provider
- Prognosis for babies born to infected mother also is very positive. Utmost care is required only when babies are born pre-term, as they can develop complications. However, babies born to infected mothers are carefully monitored for the infection and complications even when the birth is full-term
It must be pointed out chorioamnionitis in the mother has been linked to childhood asthma. Hence, the infection increases the risk of your baby developing asthma
A Word Of Caution:
Chorioamnionitis should not be taken lightly. It can wreak havoc with yours and your baby’s health. So, any sign of infection should never be disregarded. You should immediately consult your OB/GYN if:
- You notice leaking of amniotic fluid, even if the volume of the leak is small
- You notice your urine has an ammonia-like odor
- You notice the amniotic fluid has a foul odor
While there are screening methods to prevent and diagnose chorioamnionitis, you should realize they are not foolproof. Hence, prevention of chorioamnionitis has to be a concerted effort by the doctor and their team and the mother.
Chorioamnionitis afflicts many pregnant women across the world and typically it develops when the woman has prolonged labor or protracted membrane rupture. Based on certain clinical symptoms, such as maternal fever, histologic testing of the placenta and umbilical cord and positive results in amniocentesis, doctors can easily diagnose the presence of the infection. Administrating of antibiotics helps treat the infection successfully and also plays an important role in prolonging the time of delivery and ensuring positive neonatal outcomes.
Have you been diagnosed with chorioamnionitis? What were your experiences during your pregnancy? We would love to hear from you. So, feel free to comment on this article.
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