Chorioamnionitis and endometritis

Chorioamnionitis complicates 1% to 2% of all pregnancies and may affect 10% of women with certain risk factors. Intraamnionic infection may result in devastating morbidity for both the fetus and the mother. Also, chorioamnionitis is associated with higher cesarean section rates. As demonstrated earlier, endometritis is a common complication of cesarean delivery alone. Nevertheless, antibiotic prophylaxis has been shown to reduce postpartum morbidity. In the face of chorioamnionitis and a cesarean delivery, the risk of developing endometritis increases exponentially. However, if appropriate antibiotic therapy is instituted at the time of diagnosis, fetal and maternal outcomes improve dramatically. Similar to chorioamnionitis, endometritis is usually polymicrobial in nature. The preponderance of the organisms isolated are anaerobic. Established risk factors include operative delivery, prolonged ruptured fetal membranes, and prolonged labor. The diagnosis is based primarily on clinical examination with fever and the exclusion of other sources of extrapelvic infection. Once the diagnosis is established, appropriate empiric antibiotics are instituted. Antibiotic therapy should be continued until the patient is afebrile and asymptomatic for 24 to 36 hours. Over the past 20 years, the use of single-agent therapy in these serious infections has been shown to be safe as well as effective. Once successful therapy is completed, the patient is discharged home with no oral antibiotics.