CHORIOAMNIONITIS

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.

  • 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
  • Advise the mother on how to recognize danger signs