Chorioamnionitis Woods

CHORIOAMNIONITIS: A HIDDEN CAUSE OF NEONATAL DEATH Professor David Woods Neonatal Medicine Department University of Cape Town, South Africa

Process of colonization • Ascending spread from vagina and cervix • Bacteria – usually anaerobic • Dilated cervix to expose membranes • Colonization of chorion and amnion • Spread to placenta • Colonization of amniotic fluid • Colonization or infection of fetus

Why not transplacental? • Classic twin study: – Often first twin only – Sometimes both twins – Never second twin only • Respiratory distress in twins: – Twin A gets congenital pneumonia – Twin B has pulmonary immaturity

Bacterial vaginosis • Deranged vaginal flora • Lactobacillus replaced • Gardnerella, Bacteroides • Pathogens • Discharge, itch and fishy smell • Alkaline pH on litmus testing • Clue cells: bacteria coated epithelial cells • Metronidazole or clindamycin • Normalise vaginal flora

Dangers of chorioamnionitis • Initiate preterm labour or prelabour rupture of the membranes • Chorioamnionitis leading to placentitis with villous oedema • Amnionitic fluid colonisation with fetal infection

Acute inflammatory response in the placenta Mild: Maternal response below the chorion only Moderate: Maternal response involving the chorion Severe: Fetal response with vasculitis

Management of chorioamnionitis

• Promote normal vaginal flora • Role of antibiotics • Prophylaxis in the mother • Diagnosis at birth • Treatment in the newborn infant