Treatment of Clinical Chorioamnionitis: Maternal Fever with Two or More Clinical Signs at ≥34 Weeks' Gestation

Clinical chorioamnionitis at ≥34 weeks' gestation is diagnosed when maternal fever occurs alongside two or more qualifying clinical signs. Prompt, structured management — addressing both infection control and delivery planning — is indicated once the diagnosis is established.

Clinical Scenario Diagnosis is made by the presence of maternal fever plus two or more of the following: maternal tachycardia, fetal tachycardia, uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, or maternal leukocytosis. This protocol applies from gestational age ≥34 weeks 0 days.

Treatment Goals Resolution of clinical chorioamnionitis within 16 hours of treatment; reduction of maternal temperature and resolution of fetal tachycardia following antipyretic administration.

Approach Overview Management centres on intravenous antibiotic therapy, with agent selection guided by mode of delivery and the patient's penicillin-allergy status, combined with antipyretic support. Delivery should be considered once the diagnosis is confirmed, regardless of gestational age. The complete regimen — including specific agent selection, regimen sequencing, and delivery criteria — is available in the full protocol.

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References

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. Vaginal delivery is the safer option and cesarean delivery should be reserved for standard obstetric indications.

Acetaminophen administration resulted in a mean decrease in temperature of 1.2°C.

DOI: 10.1016/j.ajog.2020.09.044

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