Case 51 - A 30-Year-Old at 39 Weeks’ Gestation with Fever in Labor

Summary

Intraamniotic infection (IAI) is a serious infection that complicates up to 13% of term labor. Definitive diagnosis of IAI requires the presence of both microbial infection and inflammatory markers such as neutrophils and cytokines in the amniotic cavity. Current microbiologic and diagnostic tests for inflammation take hours to days to return and, therefore, clinicians must rely on clinical signs to determine the need for treatment. Suspected IAI or “clinical chorioamnionitis” is defined as unexplained maternal fever (>38°C or 100.4°F) with one or more of the following symptoms or signs: 1) uterine tenderness and irritability; 2) leukocytosis; 3) fetal tachycardia; 4) maternal tachycardia; or 5) malodorous vaginal discharge. It is associated with significant morbidity for both the mother and neonate. Maternal complications include protracted labor, uterine atony, postpartum hemorrhage, wound infection, sepsis, and intensive care admission. Neonatal morbidity includes an increased risk for neonatal intensive care admission, pneumonia, meningitis, sepsis, and death. Prompt identification and treatment of intraamniotic infection with broad-spectrum antibiotics may decrease the morbidity associated with this infection. It is not an indication for immediate cesarean delivery, and standard obstetric guidelines should be followed to determine delivery route.