| Chorioamnionitis is an ascending infection of the vaginal flora into the ruptured amniotic sac, and chorion, which is why it is so important to culture, and, if after 37 weeks, to deliver the baby. Chorioamnionitis is defined by clinical signs and symptoms of maternal fever greater than 100.4 degrees Fahrenheit, maternal heart rate greater than 120 beats per minute, fetal tachycardia (greater than 160-180 bpm), uterine tenderness, maternal leukocytosis, in the range of 15,000 to 18,000 cells/microliter, and a purulent and foul smelling amniotic fluid or vaginal discharge. When 2 or more of these criteria are present, the risk of neonatal sepsis is increased. [12]
Empiric ampicillin is given to protect the infant from group B streptococcus if there is evidence of infection or if delivery will be precipitous. The delivery itself may progress rapidly in the case of chorioamnionitis, but infection may also cause uterine atony, requiring oxytocin, or even instrument or caesarean delivery. |