Continuation of antibiotics is not required after vaginal delivery, as risk of endometritis is low. Postpartum management should be individualized based on route of delivery. Regardless of whether or not antibiotics are initiated, it is essential to notify the pediatric care team of the maternal fever, as this greatly impacts the evaluation and treatment of the neonate, who may warrant additional laboratory analysis, antimicrobial treatment, and hospitalization in the intensive care unit. The decision to proceed with cesarean delivery should be based on obstetric indications. Amnionitis alone is not an indication for immediate cesarean, and labor should be actively managed following standard guidelines. Appropriate hydration and antipyretics should also be given. Alternative regimens include ampicillin-sulbactam or piperacillin-tazobactam. In patients with a mild penicillin allergy, cefazolin and gentamicin are recommended and in patients with a severe penicillin allergy gentamycin and either clindamycin or vancomycin are recommended. Ampicillin and gentamicin are standard treatment for IAI to decrease the risk of neonatal sepsis and maternal morbidity. Antibiotics should be considered in the setting of isolated maternal fever unless another source is identified. Once IAI is preliminarily diagnosed, antibiotic therapy is recommended. epidural anesthesia, dehydration, and prostaglandin induction agents). pyelonephritis or pneumonia), as well as for non-infectious causes (e.g. Isolated fever between 38C and 39C warrants an evaluation for extra-uterine infections (e.g. IAI can be confirmed after delivery by placental pathology findings of chorioamnionitis or growth of bacteria in culture. Fundal tenderness and maternal tachycardia are no longer considered among diagnostic criteria as these features may be altered by labor and analgesia or anesthesia.
Additionally, ACOG recommends that IAI be suspected in patients with an isolated fever of 39 C or greater. IAI should be suspected in the setting of maternal fever 38-38.9 C without a clear source AND at least one of the following clinical findings: baseline fetal tachycardia (>160 bpm for at least 10 min), maternal leukocytosis (>15,000 per mm2 in the absence of corticosteroids), and purulent cervical discharge. Neonates can suffer acute events such as pneumonia, meningitis, sepsis, and death, as well as long-term sequelae of bronchopulmonary dysplasia and cerebral palsy.Įstablishing concern for IAI is key to initiating appropriate treatment and minimizing adverse outcomes. Potential maternal consequences of IAI include dysfunctional labor, postpartum hemorrhage due to atony, endometritis, sepsis, and rarely death. Other associated factors include multiple vaginal exams, meconium, group B streptococcus, and sexually transmitted infections. The greatest risk factor for developing IAI is prolonged labor with ruptured membranes. IAI complicates approximately 2-5% of term deliveries and is often a polymicrobial infection ascending from the lower genital tract. Intraamniotic infection (IAI), or amnionitis, is an inflammatory or infectious disorder involving any combination of amniotic fluid, placenta, fetus, fetal membranes, or decidua.
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