Our bodies are strong enough to ward off many infections but a developing fetus is much more sensitive to bacteria, viruses, and fungal infections. When an infection develops in the placenta, amniotic sac, or in the fetus, it can pose a serious risk of injury to both the mother and the baby. Chorioamnionitis or intrauterine inflammation or infection is a birth complication that could cause harm or even be fatal. It is important for doctors to monitor the mother and baby and treat any birth complications.
What is Chorioamnionitis?
Chorioamnionitis is a common birth complication that can cause harm to the mother, fetus, or newborn. Also called intrauterine inflammation or infection or both, chorioamnionitis is a birth infection of the membranes surrounding the fetus. The infection can be caused by a number of bacteria or viruses. In the mother, it can lead to sepsis, and in the baby, it can cause birth injuries and fetal death.
According to one study, “chorioamnionitis occurs in about 4% of deliveries at term but occurs more frequently in preterm deliveries and premature rupture of membranes.” In preterm deliveries, between 21 and 24 weeks gestation, chorioamnionitis can be found in more than 90% of cases.
Amniotic Sac Infection
The amniotic sac is made up of an inner and outer membrane. The outer membrane is the chorion, which protects the inner layer. The inner layer is the amnion, where the fetus develops and which holds the amniotic fluid. In chorioamnionitis, the bacteria causes the amnion and chorion to swell, developing an infection in the amniotic fluid.
Causes of Chorioamnionitis
Chorioamnionitis is generally caused by exposure to harmful microorganisms. However, other obstetric problems can increase the risk of developing inflammation and infection, including uterine rupture, prolonged labor, and premature delivery. Other risk factors for developing chorioamnionitis include:
- Young maternal age
- Smoking while pregnant
- Drinking alcohol while pregnant
- First pregnancy
- Multiple invasive vaginal examinations during labor
- Pre-existing infections of the genital tract
The source of infection generally comes from bacteria but can also be caused by viral or fungal infections. The most common causes of chorioamnionitis are:
- Streptococcus (including MRSA (Methicillin-resistant Staphylococcus aureus)
Other bacteria that have been shown to cause amnionitis include:
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- E. coli
- Candida (yeast infection)
The source of these infections can vary, with some bacteria existing already in or on the mother. Other infections can be transmitted through sexual contact, touching contaminated surfaces, eating contaminated food, or through hospital-acquired infection.
Signs of Chorioamnionitis and Symptoms
It may be difficult for the mother to know she has an infection in the amniotic fluid without getting a blood test. In some mothers, there are no symptoms. In other cases, chorioamnionitis can cause:
- Fever or high temperature
- Rapid maternal heart rate
- Rapid fetal heart rate
- Uterine tenderness, feeling like cramping or heaviness in the pelvic area
- Leaking amniotic fluid
- Discolored or foul liquid coming from the vagina
A diagnosis for chorioamnionitis is usually made with a physical examination and taking blood samples from the mother. However, a diagnosis may not be confirmed until after delivery. A maternal blood test may look for the presence of bacteria or other indicators that there is an infection, including leukocytosis, where the white blood cell count is above normal. A higher rate of white blood cells may be a sign of an inflammatory response.
Amniocentesis is a prenatal test that takes a sample of the amniotic fluid. The fluid can be tested for a number of health conditions, including to determine if there is a bacterial infection and the type of infection.
Complications of Bacterial Infections
There are potential complications for the mother, fetus, and baby because of a bacterial infection and/or inflammation. The short and long-term complications may depend on the type of infection, extent of infection, whether the infection is treated, and what happens during labor and after delivery. Complications for the mother include:
- Postpartum hemorrhage
- Preterm birth
- Pelvic abscess
- C-section wound infection
In the fetus, chorioamnionitis can cause neonatal sepsis or fetal death. For the neonate, complications may include:
- Septic shock
- Neonatal pneumonia
- Preterm birth
- Brain disease
- Lung disease
Brain damage may be caused by the fetal inflammatory response. When a fetus or baby suffers a brain injury, it can cause permanent damage. Infant brain injury can be caused by oxygen deprivation, or hypoxic-ischemic encephalopathy (HIE). Brain injuries can include intraventricular hemorrhage, periventricular leukomalacia, or cerebral palsy.
Treatment for Chorioamnionitis
Early recognition of a possible infection is an important factor in the overall outcome. Treatment for mothers with suspected chorioamnionitis includes antibiotic treatment, which may involve intrapartum treatment and postpartum treatment. Intrapartum treatment is associated with shorter hospital stays for the mother and baby. If there is a uterine rupture or release of amniotic fluid early in the pregnancy, administering antibiotics may be able to prevent chorioamnionitis.
Treatment for fever that does not have an identifiable cause may also include antibiotic treatment, as well as fever-reducing medications, like acetaminophen.
Chorioamnionitis and Medical Malpractice
Chorioamnionitis can be caused by a number of possible infections. It is important for doctors and healthcare professionals to be aware of the signs and symptoms of intraamniotic infection or inflammation in a pregnant woman. Pregnant patients with fever, cramping, or after a leak of amniotic fluid should be closely monitored and tested to make sure they and their unborn babies are healthy. Failure to properly test or monitor these patients is not only dangerous to the mother and child, it may also be medical malpractice.
Medical malpractice does not mean that the doctor intentionally harmed the patient. Medical malpractice is the failure of a doctor to provide the standard of care that other doctors would have provided under similar conditions. If a doctor fails to properly treat, monitor, or assist a patient, the doctor may be liable for any damages caused.
Chorioamnionitis Birth Injury Attorneys
If a medical mistake involving an infection in the amniotic fluid caused a birth injury in your child, talk to an experienced medical malpractice attorney about holding the doctors and healthcare systems accountable. Do not hesitate to contact Gilman & Bedigian today for a free consultation.