Chorioamnionitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Chorioamnionitis is an inflammatory condition of pregnancy affecting the uterus. It is a bacterial infection of the amniotic sac and the surrounding amniotic fluid. Chorioamnionitis is extremely dangerous to both the mother and fetus and is the most common cause of premature labor. Chorioamnionitis may be classified into several subtypes based on the presentation of the patient, the type of infiltrating cells, anatomical regions infiltrated by neutrophils (stage), and the intensity of inflammation (grade). Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The opaque appearance of fetal membranes is a characteristic gross pathologic finding of chorioamnionitis. neutrophilic infiltration of the amniotic cavity and/or chorionic plate is the characteristic microscopic finding of chorioamnionitis. Chorioamnionitis may be caused by either bacterial, fungal, or viral microorganisms. Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain. Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period. Extrauterine infections should be considered in patients with fever and abdominal pain. And lastly, noninfectious conditions such as placental abruption should be considered in patients with abdominal pain in the absence of fever. The prevalence of chorioamnionitis was estimated to be approximately 4,000 cases per 100,000 individuals worldwide. Chorioamnionitis more commonly affects individuals < 18 years of age. Gestational age is also a strong predictor of chorioamnionitis with increased prevalence in people who delivered between 21 and 24 weeks of gestation. Male infants are more commonly affected than females. Chorioamnionitis usually affects individuals of Hispanics and Asian/Pacific Islanders. Common risk factors in the development of chorioamnionitis include preterm premature rupture of membranes (PPROM), prematurity, nulliparity, prolonged labor and rupture of membranes, multiple digital vaginal examinations, meconium stained amniotic fluid, internal fetal monitoring, epidural anesthesia, immunocompromised state, maternal behavioral conditions, and infections. Clinical findings associated with chorioamnionitis include maternal fever, uterine tenderness, purulent/foul-smelling amniotic fluid, maternal/fetal tachycardia. Common fetal complications of chorioamnionitis include preterm birth, neonatal sepsis, neurologic complications, respiratory complications. Common maternal complications of chorioamnionitis include maternal sepsis, infections, and labor-related complications (e.g., cesarean section, postpartum hemorrhage, etc.). There is no single diagnostic study of choice for the diagnosis of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, laboratory findings, and/or histopathologic evaluation. The diagnosis of clinical chorioamnionitis is solely based on clinical features include maternal fever, uterine tenderness, maternal/fetal tachycardia, and foul-smelling/purulent amniotic fluid. And the gold standard (test) for the diagnosis of chorioamnionitis is a microbiological culture of the amniotic fluid. Common physical examination findings of chorioamnionitis include fever, abdominal pain, uterine tenderness, tachycardia, and foul-smelling vaginal discharge. Laboratory findings consistent with the diagnosis of chorioamnionitis include maternal leukocytosis, left shift or elevated band count, amniotic fluid findings (e.g., positive amniotic fluid microbiological culture results, bacteria or white blood cells on gram stain, decreased glucose level, elevated IL-6 level, etc.), and histologic findings such as neutrophilic infiltration of chorioamniotic membranes. There are no ECG findings associated with chorioamnionitis. There are no x-ray findings associated with chorioamnionitis. There are no ultrasound findings associated with chorioamnionitis. However, an ultrasound may be helpful in the diagnosis of complications of chorioamnionitis, which include postpartum hemorrhage, pelvic abscesses, endomyometritis, intraventricular hemorrhage, periventricular leukomalacia, respiratory distress syndrome, and bronchopulmonary dysplasia. There are no CT scan findings associated with chorioamnionitis. However, a CT scan may be helpful in the diagnosis of complications of chorioamnionitis, which include pelvic infections and abscesses, adrenal abscesses, and subphrenic abscess. There are no MRI findings associated with chorioamnionitis. However, an MRI may be helpful in the diagnosis of complications of chorioamnionitis, which include spontaneous preterm delivery, white matter injury (WMI), and intraventricular hemorrhage (IVH). Magnetic resonance spectroscopy(MRS) may be helpful for the detection of neuroinflammation during histologic chorioamnionitis. Furthermore, it may suggest a poor neurodevelopmental outcome (e.g. motor development, cognitive development, etc.) in these infants. There are no other diagnostic studies associated with chorioamnionitis. Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of ampicillin and gentamicin. Supportive therapy, such as antipyretics, may also be used. Surgical intervention is not recommended for the management of chorioamnionitis. Effective measures for the primary prevention of chorioamnionitis include induction of labor after 34 weeks of gestation and administration of prophylactic antimicrobial therapy in the presence of preterm premature rupture of membranes (PPROM). There are no established measures for the secondary prevention of chorioamnionitis.

Chorioamnionitis may be classified into several subtypes based on the presentation of the patient, the type of infiltrating cells, anatomical regions infiltrated by neutrophils (stage), and the intensity of inflammation (grade).

Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The opaque appearance of fetal membranes is a characteristic gross pathologic finding of chorioamnionitis. neutrophilic infiltration of the amniotic cavity and/or chorionic plate is the characteristic microscopic finding of chorioamnionitis.

Chorioamnionitis may be caused by either bacterial, fungal, or viral microorganisms.

Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain. Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period. Extrauterine infections should be considered in patients with fever and abdominal pain. And lastly, noninfectious conditions such as placental abruption should be considered in patients with abdominal pain in the absence of fever.

The prevalence of chorioamnionitis was estimated to be approximately 4,000 cases per 100,000 individuals worldwide. Chorioamnionitis more commonly affects individuals < 18 years of age. Gestational age is also a strong predictor of chorioamnionitis with increased prevalence in people who delivered between 21 and 24 weeks of gestation. Male infants are more commonly affected than females. Chorioamnionitis usually affects individuals of Hispanics and Asian/Pacific Islanders.

Common risk factors in the development of chorioamnionitis include preterm premature rupture of membranes (PPROM), prematurity, nulliparity, prolonged labor and rupture of membranes, multiple digital vaginal examinations, meconium stained amniotic fluid, internal fetal monitoring, epidural anesthesia, immunocompromised state, maternal behavioral conditions, and infections.

Clinical findings associated with chorioamnionitis include maternal fever, uterine tenderness, purulent/foul-smelling amniotic fluid, maternal/fetal tachycardia. Common fetal complications of chorioamnionitis include preterm birth, neonatal sepsis, neurologic complications, respiratory complications. Common maternal complications of chorioamnionitis include maternal sepsis, infections, and labor-related complications (e.g., cesarean section, postpartum hemorrhage, etc.)

There is no single diagnostic study of choice for the diagnosis of chorioamnionitis, but chorioamnionitis can be diagnosed based on the clinical presentation, laboratory findings, and/or histopathologic evaluation. The diagnosis of clinical chorioamnionitis is solely based on clinical features include maternal fever, uterine tenderness, maternal/fetal tachycardia, and foul-smelling/purulent amniotic fluid. And the gold standard (test) for the diagnosis of chorioamnionitis is a microbiological culture of the amniotic fluid.

The hallmark of chorioamnionitis is maternal fever. The presence of uterine tenderness, purulent/foul-smelling amniotic fluid, and maternal/fetal tachycardia is suggestive of chorioamnionitis.

Common physical examination findings of chorioamnionitis include fever, abdominal pain, uterine tenderness, tachycardia, and foul-smelling vaginal discharge.

Laboratory findings consistent with the diagnosis of chorioamnionitis include maternal leukocytosis, left shift or elevated band count, amniotic fluid findings (e.g., positive amniotic fluid microbiological culture results, bacteria or white blood cells on gram stain, decreased glucose level, elevated IL-6 level, etc.), and histologic findings such as neutrophilic infiltration of chorioamniotic membranes.

There are no ECG findings associated with chorioamnionitis.

There are no x-ray findings associated with chorioamnionitis.

There are no ultrasound findings associated with chorioamnionitis. However, an ultrasound may be helpful in the diagnosis of complications of chorioamnionitis, which include postpartum hemorrhage, pelvic abscesses, endomyometritis, intraventricular hemorrhage, periventricular leukomalacia, respiratory distress syndrome, and bronchopulmonary dysplasia.

There are no CT scan findings associated with chorioamnionitis. However, a CT scan may be helpful in the diagnosis of complications of chorioamnionitis, which include pelvic infections and abscesses, adrenal abscesses, and subphrenic abscess.

There are no MRI findings associated with chorioamnionitis. However, an MRI may be helpful in the diagnosis of complications of chorioamnionitis, which include spontaneous preterm delivery, white matter injury (WMI), and intraventricular hemorrhage (IVH).

Magnetic resonance spectroscopy(MRS) may be helpful for the detection of neuroinflammation during histologic chorioamnionitis. Furthermore, it may suggest a poor neurodevelopmental outcome (e.g. motor development, cognitive development, etc.) in these infants.

There are no other diagnostic studies associated with chorioamnionitis.

Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of ampicillin and gentamicin. Supportive therapy, such as antipyretics, may also be used.

Surgical intervention is not recommended for the management of chorioamnionitis.

Effective measures for the primary prevention of chorioamnionitis include induction of labor after 34 weeks of gestation and administration of prophylactic antimicrobial therapy in the presence of preterm premature rupture of membranes (PPROM).

There are no established measures for the secondary prevention of chorioamnionitis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

There is limited information about the historical perspective of chorioamnionitis.

There is limited information about the historical perspective of chorioamnionitis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Chorioamnionitis may be classified into several subtypes based on the presentation of the patient, the type of infiltrating cells, anatomical regions infiltrated by neutrophils (stage), and the intensity of inflammation (grade).

Chorioamnionitis may be classified into several subtypes based on the presentation of the patient, the type of infiltrating cells, anatomical regions infiltrated by neutrophils (stage), and the intensity of inflammation (grade).^[1]

• Chorioamnionitis may be classified according to the absence or presence of clinical signs and laboratory findings into two groups: clinical chorioamnionitis, and subclinical/histologic chorioamnionitis.^[2][3]
  • Subclinical/histologic chorioamnionitis indicates the inflammation of the chorion, amnion, and placenta in the absence of clinical signs.
    • Diagnosis of histologic chorioamnionitis is mainly based on the evaluation of pathology which might be confirmed by the presence of inflammatory cells within the fetal membranes.
  • The presence of maternal fever, leukocytosis, maternal/fetal tachycardia, uterine tenderness, foul-smelling amniotic fluid, and preterm rupture of membranes (PROM) indicates the clinical chorioamnionitis.
• Chorioamnionitis may be classified into acute and chronic forms, depending on the type of infiltrating cells.^[4]
  • Acute and chronic chorioamnionitis indicate the infiltration of the fetal membranes by PMNs and monocytes, respectively.
• The staging of chorioamnionitis is based on the anatomical regions infiltrated by neutrophils.^[1]
  • Stage 1 represents the infiltration of chorion or subchorionic space by neutrophils.
  • Stage 2 represents the infiltration of chorionic connective tissue and/or amnion or the chorionic plate by neutrophils.
  • Stage 3 represents the necrotizing chorioamnionitis, indicates the edema and necrosis of the amniotic epithelium.
• The grading of chorioamnionitis is based on the intensity of inflammation.^[1]
  • Grade 1, mild to moderate inflammation, represent the infiltration of fetal membranes by small clusters of maternal neutrophils.
  • Grade 2, severe inflammation, represents the presence of at least 3 chorionic microabscesses (cluster of neutrophils measuring ≥ 10 x 20 cells) or the presence of neutrophils of ≥ 10 cells in width that involve at least half of the subchorionic fibrin or one cycle around the membrane roll.
• The staging system might be more effective to establish the severity of inflammation than the grading system.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The opaque appearance of fetal membranes is a characteristic gross pathologic finding of chorioamnionitis. neutrophilic infiltration of the amniotic cavity and/or chorionic plate is the characteristic microscopic finding of chorioamnionitis.

Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The pathogenesis can be further divided into 4 categories based on the anatomical route of the introduction of the microorganism:^[1]

• Ascending infection might originate from the maternal genital tract (the most common route).
  • Vaginal and enteric flora are usually transmitted via the ascending route to the fetal membranes.
• Iatrogenic infection might be caused by invasive procedures (e.g., amniocentesis).
• Maternal infections such as listeria monocytogenes, might infect fetal membranes through the placenta by the hematogenous route.
• In mothers with hepatic or renal diseases, the infection of fetal membranes might be originated by peritoneal infections via the route of fallopian tubes.

Genes involved in the pathogenesis of chorioamnionitis include:^[2][3]

• Placental IL-6 (minor C allele at the IL6 SNP)
• IL10
• MBL2
• TNFRSF6
• TGFB1

On gross pathology, the opaque appearance of fetal membranes is a characteristic finding of chorioamnionitis.^[4]

• The presence of opaque fetal membranes might indicate an increased risk of complications of chorioamnionitis in newborns.

On microscopic histopathological analysis, neutrophilic infiltration of the amniotic cavity and/or neutrophilic infiltration of the chorionic plate are characteristic findings of chorioamnionitis.^[5]

• Decidua of the placenta is originated from the mother which might include the neutrophils of mother.
• Chorioamnionic membranes are originated from the fetus which do not include neutrophils in physiologic settings. However, in case of chorioamnionitis, maternal neutrophils migrate into these membranes in the presence of chemotaxis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2] ; Luke Rusowicz-Orazem, B.S.

Chorioamnionitis may be caused by either bacterial, fungal, or viral microorganisms.^[1]

Common bacterial causes of chorioamnionitis include:^[1][2]

• Bacteroides sp., especially Prevotella bivius
• Streptococcus agalactiae
• Enterobacteriaceae
• Gardnerella vaginalis
• Mycoplasma pneumoniae
• Chlamydia trachomatis
• Ureaplasma urealyticum
• Fusobacteria sp.
• Escherichia coli
• Viruses (adenoviruses might be associated with histological inflammation.
• Fungi, especially candida, might be the causative agent of chorioamnionitis especially in women who become pregnant while using intrauterine devices.^[2]
  • Chorioamnionitis due to candida infection is associated by preterm birth and adverse fetal outcomes.^[1]
• Trichomonas vaginalis might be the causative microorganism in chorioamnionitis, particularly in young and sexually active patients.

Common causative pathogens could be further divided based on the clinical outcome

• Certain microorganisms which might be seen in patients with spontaneous preterm labor (intact membranes):
  • Fusobacterium nucleatum
  • Sneathia sanguinegens
  • Ureaplasma urealyticum
  • Streptococcus mitis
  • Gardnerella vaginalis
  • Peptostreptococcus
  • Leptotrichia amnionii
  • Mycoplasma hominis
  • Streptococcus agalactiae
  • Lactobacillus species
  • Bacillus species
  • Coagulase-negative Staphylococcus species
  • Prevotella species
  • Delftia acidovorans
  • Neisseria cinerea
• Certain microorganisms which might be seen in patients with clinical chorioamnionitis at term:
  • Ureaplasma urealyticum
  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Streptococcus agalactiae
  • Lactobacillus species
  • Bacteroides species
  • Acinetobacter species
  • Sneathia
  • Streptococcus viridans
  • Porphyromonas species
  • Veillonella species
  • Peptostreptococcus species
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Eubacterium species
  • Gram negative bacilli
  • Enterococcus species
  • Fusobacterium species
  • Candida species
  • Micrococcus luteus
  • Firmicute
  • Propionibacterium acnes
  • Abiotrophia defective
  • Staphylococcus epidermidis

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Escherichia coli
Genetic	No underlying causes
Hematologic	Mycoplasma hominis
Iatrogenic	No underlying causes
Infectious Disease	Adenovirus, Bacteroides  , Candida albicans, Chlamydia trachomatis, Endometritis, Enterobacteriaceae, Escherichia coli, Fusobacteria sp., Gardnerella vaginalis  , Gram-negative anaerobes , Listeria monocytogenes, Mycoplasma hominis  , Prevotella bivius, Streptococcus group b, Streptococcus group a, Ureaplasma urealyticum
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Mycoplasma hominis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	Chlamydia trachomatis, Endometritis, Prolonged labor
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	Gardnerella vaginalis
Trauma	No underlying causes
Urologic	Urinary tract infection
Miscellaneous	No underlying causes

• Adenovirus
• Bacteroides
• Candida albicans
• Chlamydia trachomatis
• Enterobacteriaceae
• Escherichia coli
  • Fusobacteria sp.
• Gardnerella vaginalis
• Gram-negative anaerobes
• Group B Streptococcus
• Listeria monocytogenes
• Mycoplasma hominis
• Mycoplasma pneumoniae
• Prevotella bivius
• Ureaplasma urealyticum

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain. Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period. Extrauterine infections should be considered in patients with fever and abdominal pain. And lastly, noninfectious conditions such as placental abruption should be considered in patients with abdominal pain in the absence of fever.

Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain.^[1]

• Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period.
• Extrauterine infections should be considered in patients with fever and abdominal pain. Extrauterine infections that must be differentiated from chorioamnionitis include:
  • Appendicitis
  • Pneumonia
  • Influenza
  • Pyelonephritis and other urinary tract infections
• Noninfectious conditions should be considered in patients with abdominal pain in the absence of fever. Noninfectious conditions that must be differentiated from chorioamnionitis include:
  • Thrombophlebitis
  • Placental abruption
  • Colitis
  • Connective tissue disorders
  • Round ligament pain

Chorioamnionitis, must be differentiated from other diseases that may cause, fever, abdominal pain, and maternal/fetal tachycardia. The table below, summarizes the differential diagnosis for chorioamnionitis:

Disease	Findings
Epidural-Related Fever	Intrapartum fever (≥38 °C), Absence of other clinical findings of intrauterine inflammation (abdominal pain, maternal/fetal tachycardia, etc.)[2][1]
Appendicitis	Presents with abdominal pain that begins around the umbilicus, then migrates to the right lower quadrant (relatively rare but also possible at right upper quadrant), nausea vomiting, abdominal guarding, deep tenderness at MBburney’s point, dysuria[3]
Pneumonia	Presents with fever, productive cough, pleuritic chest pain, dyspnea, rigor, perspiration, and findings on auscultation such as inspiratory rales localized to the affected area
Influenza	Presents with acute fever, headache, cough, rigor, perspiration, myalgias, and malaise[4]
Pyelonephritis	Presents with fever, chills, malaise, dysuria, urinary urgency, polyuria, nausea, flank pain[5]
Others	Thrombophlebitis, placental abruption, colitis, connective tissue disorders, and round ligament pain can produce abdominal pain that may be confused with chorioamnionitis. However, the absence of fever indicates these conditions rather than chorioamnionitis.[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

The prevalence of chorioamnionitis was estimated to be approximately 4,000 cases per 100,000 individuals worldwide. Chorioamnionitis more commonly affects individuals < 18 years of age. Gestational age is also a strong predictor of chorioamnionitis with increased prevalence in people who delivered between 21 and 24 weeks of gestation. Male infants are more commonly affected than females. Chorioamnionitis usually affects individuals of Hispanics and Asian/Pacific Islanders.

• Worldwide, the prevalence of chorioamnionitis is approximately 4,000 per 100,000 persons.^[1]
  • In developed countries, the prevalence of chorioamnionitis is 970 per 100,000 persons.^[2]

• Chorioamnionitis is more commonly seen in patients < 18 years of age.^[2]

• The prevalence of chorioamnionitis decreases with gestational age until 37-40 weeks of gestation, then slightly increases again.
  • Chorioamnionitis most commonly affects patients who delivered between 21 and 24 weeks of gestation.
    • It is worth mentioning that the frequency of chorioamnionitis is approximately 94% in this group. ^[3]

• Male infants are more commonly affected with chorioamnionitis than female infants.^[2]

• Chorioamnionitis usually affects individuals of non-White races. White individuals are less likely to develop chorioamnionitis.^[2]
  • Chorioamnionitis is more prevalent in Hispanics and Asian/Pacific Islanders.
  • Although individuals of the Black race usually less affected than Hispanics and Asian/Pacific Islanders, the prevalence of chorioamnionitis is higher in individuals of the black race than whites.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2] ; Abdurahman Khalil, M.D. [3]

Common risk factors in the development of chorioamnionitis include preterm premature rupture of membranes (PPROM), prematurity, nulliparity, prolonged labor and rupture of membranes, multiple digital vaginal examinations, meconium stained amniotic fluid, internal fetal monitoring, epidural anesthesia, immunocompromised state, maternal behavioral conditions, and infections.

Common risk factors in the development of chorioamnionitis include:^[1][2]

• Preterm premature rupture of membranes (PPROM)
• Prolonged rupture of membranes
• Prolonged labor
• Prolonged second stage
• Intrapartum Hypertension
• Prematurity
• Postterm Pregnancy
• Nulliparity
• Cesarean section due either to fetal heart rate decelerations or dystocia
• Internal fetal monitoring
• Multiple digital vaginal examinations
• Epidural anesthesia
• Meconium stained amniotic fluid
• Immunocompromised state
• Behavioral conditions
  • Smoking
  • Alcohol
  • Drug Abuse
• Infections
  • Maternal genital tract colonization with group B Streptococcus
  • Sexually transmitted diseases (STDs)
  • Maternal genital colonization with ureoplasma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with:

• [Condition 1]
• [Condition 2]
• [Condition 3]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Clinical findings associated with chorioamnionitis include maternal fever, uterine tenderness, purulent/foul-smelling amniotic fluid, maternal/fetal tachycardia. Common fetal complications of chorioamnionitis include preterm birth, neonatal sepsis, neurologic complications, respiratory complications. Common maternal complications of chorioamnionitis include maternal sepsis, infections, and labor-related complications (e.g., cesarean section, postpartum hemorrhage, etc.)

The symptoms of chorioamnionitis usually develop during the pregnancy, and start with symptoms such as maternal fever, uterine tenderness, purulent/foul-smelling amniotic fluid, maternal/fetal tachycardia.^[1]

Fetal complications that can develop as a result of chorioamnionitis are:^[2][3]

• Preterm birth
• Retinopathy of prematurity
• Neonatal sepsis
• Neonatal death
• Neurologic complications
  • Intraventricular hemorrhage (IVH)
  • Periventricular leukomalacia (PVL)
  • Cerebral palsy
• Respiratory complications
  • Respiratory distress syndrome (RDS)
  • Bronchopulmonary dysplasia (BPD)

Maternal complications that can develop as a result of chorioamnionitis are:^[3][1]

• Maternal sepsis
• Infections
  • Severe pelvic infections and abscess
  • Wound infections
  • Endomyometritis
• Labor-related complications
  • Preterm labor
  • Cesarean section
  • Postpartum hemorrhage

The presence of cesarean delivery for dystocia, prolonged labor times (≥ 10 h), or administration of oxytocin during labor are associated with a particularly poor prognosis among infants exposed to chorioamnionitis.^[4]

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