What is Intra-amniotic Infection?
What are the Causes of Intra-amniotic Infection?Intra-amniotic infection is a polymicrobial infection, caused by ascending genital microbes such as:
- Ureaplasma urealyticum and Mycoplasma hominis are the most common causes of neonatal complications.
- Gardnerella vaginalis, Group B Streptococcus and Escherichia coli are usually a part of the vaginal flora or intestinal flora. But if these bacteria ascend the placenta through the blood, they could cause intra-amniotic infection.
- Listeria monocytogenes cause the infection of the fetus, resulting in neonatal sepsis.
- Prolonged labor – a time gap of more than 6 hours between the breaking of the amniotic sac and induction of labor.
- Multiple vaginal examinations under unhygienic conditions
- Intrauterine pressure catheters
- Urogenital or cervical infections
- Sexually transmitted infections
- Smoking, drug abuse and alcohol use
- Epidural anesthesia
- Weakened immunity in mother like poor nutrition, emotional stress, etc.
- Presence of chronic illness or infection in the mother
- Presence of meconium (the first feces of the fetus, which is dark green in color) in the amniotic fluid
What are the Symptoms and Signs of Intra-amniotic Infection?Symptoms of intra-amniotic infection may include the following:
- Fever more than 100.4°F
- Increased maternal heart rate (more than 100 beats per minute)
- Increased fetal heart rate (more than 160 beats per minute)
- Foul smelling discharge of amniotic fluid
- Abdominal pain
Complications of Intra-amniotic InfectionIntra-amniotic infection can be considered as a medical emergency as it can lead to serious complications in both the mother and the fetus. Some of the complications of intra-amniotic infection are:
- Preterm premature rupture of the amniotic fluid
- Increased risk of cesarean birth
- Bloodstream infection in the mother
- Bleeding after delivery due to hemorrhage
- Pus collection around the uterus (abscess)
- Blood clot in the legs in mother
- Decreased oxygen levels in blood during birth in the fetus
- Infections in the fetus such as pneumonia or meningitis
- Cerebral palsy
How to Diagnose Intra-amniotic Infection?Diagnosis of intra-amniotic infection involves clinical presentation of symptoms. The physicians need to rule out upper respiratory infection and urinary tract infection, before concluding the diagnosis of intra-amniotic infection.
The following tests help in the diagnosis of intra-amniotic infection:
- Histologic examination of the fetal membranes
- Blood testing for leucocytes (more than 15,000 to 18,000 cells/mm3)
- Amniotic fluid culture and testing, obtained by amniocentesis. Pus cells may be found in amniotic fluid
How do you Treat Intra-amniotic Infection?Antibiotic therapy must be started immediately after a diagnosis is made based on clinical presentation. Broad-spectrum antibiotic therapy must be given to cover both aerobic and anaerobic bacteria.
Antibiotics used for treatment of intra-amniotic infection include:
- Combination of â-lactam like penicillin and an aminoglycoside like gentamicine is commonly recommended.
- The risk of postpartum endometritis in women undergoing cesarean section can be reduced by adding Clindamycin or Metronidazole.
- Vancomycin can replace penicillin in women with penicillin allergy.
- Antipyretic administration like acetaminophen is advised in the presence of maternal or fetal tachycardia.
- If fetal tachycardia persists after maternal tachycardia is alleviated, it indicates fetal acidemia.
Prevention of Intra-amniotic InfectionMaintaining hygienic conditions and care during physical examinations goes a long way in preventing intra-amniotic infection. Antenatal education on the risks and signs and symptoms of intra-amniotic infection must be given to all pregnant women. The importance of reporting any vaginal discharge and symptoms of urinary infection must be emphasized.
If intra-amniotic infection is diagnosed in a preterm woman, antibiotic and antipyretic treatment must be initiated immediately. Appropriate management of labor and other measures to ensure the well being of the fetus must be taken.
- Maintain proper hygienic conditions during pregnancy and keep the pubic area clean and dry.
- Avoid physical contacts or sex with persons who are infected with any kind of bacteria.
- Avoid smoking, drugs and alcohol during and before pregnancy.
- Maintain good health with proper nutritional diet and regular exercise.
- Take medications for any existing infections to treat them properly.
- Report any signs of urogenital infections like discharge or itching in the genital area.
- Insist on using well-maintained equipment during physical examinations.
- Avoid multiple vaginal examinations when you are pregnant, since there could be an increased risk of intra-amniotic infection. Talk to your health care provider for proper guidance.