This protocol covers clinical chorioamnionitis at a gestational age of ≤22 6/7 weeks, where the diagnosis is established by the presence of maternal fever in combination with two or more corroborating clinical signs.
Clinical chorioamnionitis is diagnosed by maternal fever (temperature ≥37.8 °C or ≥38.0 °C) plus two or more of the following signs:
Once the diagnosis is confirmed, the cornerstone of management is intravenous antibiotic therapy, with regimen selection guided by patient-specific factors. Antipyretic treatment is included as an adjunct to address maternal fever, and may also help resolve associated fetal tachycardia. Delivery is an integral consideration regardless of gestational age — the complete protocol specifies the applicable clinical approach and obstetric context.
Treatment targets: resolution of clinical chorioamnionitis within 16 hours; reduction of maternal temperature and resolution of fetal tachycardia following antipyretic administration.
DOI: 10.1016/j.ajog.2020.09.044
Clinical chorioamnionitis has been traditionally diagnosed by the presence of maternal fever (temperature ≥37.8°C or ≥38.0°C) plus two or more of the five following clinical signs: maternal tachycardia (heart rate >100 beats/min), fetal tachycardia (heart rate >160 beats/min), uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, and maternal leukocytosis (white blood cell count >15,000/mm³).
In summary, although there is insufficient data to demonstrate the most appropriate antimicrobial regimen for the treatment of this obstetric condition, current available evidence indicates that women with clinical chorioamnionitis, mainly those with a gestational age ≥34 weeks and in labor, can be treated with ampicillin 2 g IV every 6 hours combined with gentamicin 5 mg/kg every 24 hours or 1.5 mg/kg every 8 hours, or ampicillin/sulbactam 3 g IV every 6 hours.
Once a diagnosis of clinical chorioamnionitis has been established, delivery should be considered, regardless of the gestational age.
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