La chorioamnionite clinique à ≥34 semaines de gestation est diagnostiquée lorsque la fièvre maternelle survient en association avec deux ou plusieurs signes cliniques qualifiants. Une prise en charge rapide et structurée — portant à la fois sur le contrôle de l'infection et la planification de l'accouchement — est indiquée dès que le diagnostic est établi.
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
View source ↗