Background &
risk factors
risk factors
Intraamniotic infection, also referred to as chorio-amnionitis, is an infection with resultant inflammation of any combination of these 5 things:
amniotic fluid, placenta, fetus, fetal membranes, or decidua
Three categories of IAI are (3):
Isolated maternal fever, suspected intraamniotic infection, confirmed intraamniotic infection
It is important it inform ____ team for suspicion for IAI
pediatric
Should you continue antibiotics in the postpartum period?
Additional dose for cesarean, may continue for either cesarean or vaginal if persistent fever or concerns for bacteremia
relative risk for intraamniotic infection and neonatal infection may increase after ____ completed weeks of gestation
40
Isolated maternal fever is defined as (2):
single oral temperature of 39°C or greater, or an oral temperature of 38–38.9°C that persists when the temperature is repeated after 30 minutes.
The use of intrapartum antibiotic treatment given either in response to maternal group B streptococcal colonization or in response to evolving signs of intraamniotic infection during labor has been associated with a nearly ____fold decrease in group B streptococcal-specific neonatal sepsis
10
Standard antibiotic regimen for IAI (drug and dose):
Ampicillin (2g q6h) and gentamicin (2 mg/kg IV load followed by 1.5 mg/kg every 8 hours or 5 mg/kg IV every 24 hours)
___% of term deliveries are complicated by a clinically apparent intraamniotic infection
2-5%
Suspected intraamniotic infection is based on clinical criteria, which include maternal intrapartum fever and one or more of the following (3):
maternal leukocytosis, purulent cervical drainage, or fetal tachycardia
True or false: IAI alone is an indication for immediate delivery
False
Antibiotic regimen for IAI (mild penicillin allergy)(drug and dose):
cefazolin (2g q8h) and gentamicin (2 mg/kg IV load followed by 1.5 mg/kg every 8 hours or 5 mg/kg IV every 24 hours)
True or false: increased cervical exams contribute to IAI
False, relationship was not significant after adjusting for spontaneous labor, the Bishop score, and rupture of membranes on admission.
Confirmed intraamniotic infection is based on ____.
a positive amniotic fluid test result (gram stain, glucose level, or culture results consistent with infection) or placental pathology demonstrating histologic evidence of placental infection or inflammation.
Name 3 neonatal implications (6):
neonatal pneumonia, meningitis, sepsis, death, bronchopulmonary dysplasia, cerebral palsy
Antibiotic regimen for IAI (severe penicillin allergy)(drug and dose)
Clindamycin 900 mg q8h or Vancomycin 1g q12h and gentamicin (2 mg/kg IV load followed by 1.5 mg/kg every 8 hours or 5 mg/kg IV every 24 hours)
While IAI most often originates from vaginal flora, it can also occur after these two things:
invasive procedures (eg, amnio-centesis or chorionic villus sampling) or by a hematogenous route secondary to maternal systemic infection
True or false: maternal fever is necessary for diagnosis of IAI
FALSE
The diagnosis of suspected IAI may also be made in the absence of maternal fever when other associated clinical signs and symptoms are present such as uterine fundal tenderness, foul-smelling or purulent vaginal discharge, and leukocytosis
Delays in diagnosis and intervention, including uterine evacuation or delivery, related to the absence of fever in patients later shown to have had intraamniotic infection can significantly worsen the patient’s clinical course.
Name 4 maternal implications (7):
Dysfunctional labor requiring increased intervention, postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, adult respiratory distress syndrome and rarely death
Add either one of these two drugs on top of standard regimen after a CS for someone with IAI:
clindamycin 900 mg IV or metronidazole 500 mg IV for at least one additional dose