Chorioamnionitis

Daniel Abehsera, MD, PhD (Editor)
Obstetrics and Gynecology Department Quirón University Hospital Málaga, Spain

Series: Obstetrics and Gynecology Advances
BISAC: MED033000

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Special issue: Resilience in breaking the cycle of children’s environmental health disparities
Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick

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When we talk about chorioamnionitis, we talk about an infection that affects pregnancy itself. We talk about an infection of the fetal membranes, which can spread to the fetus itself and to the mother. There are multiple clinical situations that are very different from each other, in which chorioamnionitis is the common denominator. This monograph aims to serve as a guide to obstetricians who, in their daily work, face that great challenge that chorioamnionitis poses.

It is important to be clear about what a chorioamnionitis is, because its frequency is high and involves serious complications in pregnancy. It is undoubtedly one of the most important causes of extreme prematurity and of neonatal and maternal complications; therefore, all efforts made to reduce its incidence and mitigate its effects will necessarily improve the overall perinatal outcomes of a hospital.

Carrying out the diagnosis of chorioamnionitis is not always easy. Today there is talk of a new concept called triple I (intrauterine infection, inflammation, or both), however, diagnosing those cases in which there is no fever in the pregnant woman is a real challenge. The variability in clinical manifestations between some cases and others makes it impossible to apply the same diagnostic criteria to all patients.

The pathological examination of the placenta and fetal membranes remains a fundamental part of understanding the magnitude of chorioamnionitis symptoms. Although in order to perform the pathological examination, it is necessary that the birth of the fetus occurs. No case of chorioamnionitis can be fully studied without the pathological examination of the fetal membranes and the placenta.

It is very difficult to detect that patients are at risk of suffering from chorioamnionitis. The etiology and the routes of infection are so diverse that it is impossible to establish screening programs for the detection of patients susceptible to suffering from chorioamnionitis during pregnancy.

Complementary tests in cases of chorioamnionitis are aimed at the management of the infectious condition. Without a doubt, amniocentesis is a fundamental weapon for the management of chorioamnionitis. Unfortunately, it is not easy to implement the most complex techniques for the analysis of amniotic fluid (interleukin detection and PCR to detect bacterial DNA).

The treatment of chorioamnionitis has its fundamental pillar both in the end of pregnancy and in antibiotics. There are multiple antibiotic regimens proposed in different clinical guidelines, being in general, treatments developed in order to cover the maximum number of possible germs.

The complications of chorioamnionitis are mainly due to the fact that labor is forced prematurely, leading to gestational losses or extreme prematurity. Mothers are not exempt from complications, which may even compromise their life with systemic infections.

Probably the most complex when dealing with cases of chorioamnionitis, is the decision-making process that sometimes involves the loss of pregnancy, or an increased risk for the mother. It is the obstetrician’s job to try to maximize the chances of a healthy newborn, with the minimum commitment of the mother.
(Imprint: Nova Medicine and Health)

Preface

Chapter 1. Concept and Epidemiology
(Fernando Magdaleno MD, PhD, Marcos J Cuerva, MD, PhD, Marta Cortés, MD, PhD, and Sara López, MD, Obstetrics and Gynecology Department, La Paz University Hospital, Madrid, Spain)

Chapter 2. Clinical Manifestations and Diagnostic Criteria
(Carlos J. Corrales MD, Ana Gallardo MD snd Jose R. Andérica, MD, PhD, Obstetrics and Gynaecology Department, Malaga Regional Hospital Málaga, Spain)

Chapter 3. Microbiology of the Chorioamnionitis: Molecular Biology Techniques
(Patricia Moreno, MD, Daniel Abehsera, MD, PhD, and Marta De la Peña, MD, Obstetrics and Gynecology Department, Quironsalud Málaga Hospital, Málaga, Spain)

Chapter 4. Histology of Chorioamnionitis
(Raquel Martín, MD, Eugenia Bancalari, MD and María M. Gil, MD, PhD, Obstetrics and Gynecology Department, Torrejón University Hospital, Torrejón de Ardoz, Madrid, Spain, and others)

Chapter 5. Risk Factors: Routes of Disease Transmission
(Otilia R. González, MD, PhD, Ana R. Blázquez, MD, PhD, and Francisca S. Molina, MD, PhD, Obstetrics and Gynecology Department, San Cecilio University Hospital, Granada, Spain)

Chapter 6. Complementary Tests in Chorioamnionitis: The Role of Amniocentesis
(Rocío Revello, MD, PhD, Obstetrics and Gynecology Department, La Paz University Hospital, Madrid, Spain)

Chapter 7. Pharmacological Treatment
(Ernesto González, MD, PhD, Marta Blasco, MD, PhD, Isidoro Narbona, MD, Malaga University School of Medicine, Málaga, Spain, and others)

Chapter 8. Maternal Complications of Choriamnonitis
(Blanca Paredes, MD, María C. González, MD, Obstetrics Unit, HM Gabinete Velázquez, Madrid, Spain)

Chapter 9. Fetal and Neonatal Complications
(Pedro Azumendi MD, Lorena Sabonet, MD, Carmen Chacón, MD, Gutenberg Clinic, Málaga, Spain, and others)

Chapter 10. Clinical Situations: Obstetric Decisions
(Daniel Abehsera, MD, PhD, and Patricia Moreno, MD, Obstetrics and Gynecology Department, Quironsalud Málaga Hospital, Málaga, Spain)

Index

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