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Chorioamnionitis is an infection of the amnion and chorion (fetal parts), usually occurring during labor
Uterine infection after delivery is often called endometritis or endomyometritis, but the term "metritis" is probably most accurate to emphasize that the infection extends throughout the uterine tissue
These infections are polymicrobial and are most commonly attributed to urogenital pathogens
Risk factors for puerperal infection
Cesarean delivery (most important risk factor; risk increased 5- to 20-fold)
Prolonged labor
Use of internal monitors
Nulliparity
Multiple pelvic examinations
Prolonged rupture of membranes
Lower genital tract infections
Neonatal complications are increased in the setting of chorioamnionitis and include
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Fever not attributable to another source
Uterine tenderness
Tachycardia in the mother, fetus, or both
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Presence of fever (≥ 38°C) in the absence of any other source and one or more of the following signs:
Foul-smelling lochia may be present, but is an insensitive marker of infection
Cultures are typically not done because of the polymicrobial nature of the infection
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Empiric; broad-spectrum antibiotics that will cover
For chorioamnionitis: ampicillin, 2 g intravenously every 6 hours, and gentamicin, 2 mg/kg intravenous load then 1.5 mg/kg intravenously every 8 hours
For metritis: gentamicin, 2 mg/kg intravenous load then 1.5 mg/kg intravenously every 8 hours, and clindamycin, 900 mg intravenously every 8 hours
Antibiotics are stopped in the mother when she has been afebrile (and asymptomatic) for 24 hours; no oral antibiotics are subsequently needed
Patients with metritis who do not respond in the first 24–48 hours may have an enterococcal component of metritis and require additional gram-positive coverage (such as ampicillin) to the regimen