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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Acute chorioamnionitis occurs in approximately 1 percent of all pregnancies (Gibbs et al., 1980; Hauth et al., 1985). The majority of cases occur in the third trimester, although such infections may occur, secondary to invasive procedures such as amniocentesis or chorionic villus sampling, in the late first or early second trimester. There is no unanimity of opinion regarding specific antimicrobial regimens for the treatment of acute chorioamnionitis during pregnancy. Suggested regimens are summarized in Box 2.23. The combination of ampicillin and gentamicin is probably the most often used regimen in the United States (Gibbs et al., 1980; Gilstrap et al., 1988b; Maberry et al., 1991).
Preterm Prelabor Rupture Of Membranes
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Anna Locatelli, Sara Consonni, Annalisa Inversetti
All women with PPROM should be monitored for infection by assessment of clinical parameters (e.g. fever, maternal/fetal tachycardia, uterine tenderness, and purulent vaginal discharge). A diagnosis of chorioamnionitis is usually made by the presence of two or more of these criteria. The value of the novel definition of “Triple I” is not well defined in the context of PPROM [25]. The presence of fever of unknown origin in the presence of PPROM is highly suspicious for chorioamnionitis. The higher the incidence of chorioamnionitis, the shorter the latency period. See Chap. 24.
HIV
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jenani Jayakumaran, William R. Short
Increased risks of chorioamnionitis, postpartum endometritis, and wound infection have been reported. The risk of peripartum infection is inversely proportional to the CD4+ count at the time of delivery.
Comparison of Prenatal and Postmortem Diagnoses from 251 Fetal Autopsies: High Rate of Placenta Pathologies, Low Rate of Discrepancies
Published in Fetal and Pediatric Pathology, 2023
Jan-Theile Suhren, Kais Hussein, Hans Kreipe, Nora Schaumann
Due to improvements in ultrasound technology and genetic testing, abnormalities of large organs, skeleton and syndromal defects are usually easily detectable prenatally (2). Ultrasound may have limitations when examining small organs, such as pancreas or spleen, particularly in the early stages of pregnancy. Pulmonary hypoplasia and/or diaphragmatic defects are detectable but the degree of lung hypoplasia and therefore the likelihood of postpartum respiratory insufficiency can be difficult to assess (4, 5). Conditions like maternal obesity, oligohydramnios and fetal position can complicate sonographic evaluation (6, 7). Ultrasound may identify placental implantation site in the uterus, size, molar maturation defects, blood flow, chronic retroplacental hematomas and infarctions of the placenta (8–10). In contrast, non-molar villous maturation defects, fetal vascular malperfusion and immunologic lesions, such as villitis of unknown etiology (VUE) and chronic histiocytic intervillositis (CHI), can only be diagnosed by histopathology. While amniotic fluid infection is relatively common, clinically unapparent chorioamnionitis (approximately 10% of term pregnancies) can only be detected by histologic examination (11–14). Histology alone can discriminate between maternal-derived granulocytic inflammation in the amnion and reaction of the fetal immune system in the umbilical cord (15). This can help to differentiate between secondary amniotic fluid infection after IUFD and primary infection related to death (15).
Fulminant Sepsis and Perinatal Death at 23 Weeks Due to Fusobacterium nucleatum
Published in Fetal and Pediatric Pathology, 2023
Maria Paola Bonasoni, Giuseppina Comitini, Mariangela Pati, Marcellino Bardaro, Giuseppe Russello, Edoardo Carretto, Giulia Dalla Dea, Andrea Palicelli, Giuditta Bernardelli, Elena Chesi, Giancarlo Gargano
Despite the severe inflammation, the mother was asymptomatic except for elevated inflammatory markers. Symptomatology was unusual, as F. nucleatum chorioamnionitis usually presents with elevated temperature [10,25,35]. However, Triple I criteria define clinical chorioamnionitis as intrauterine inflammation or infection or both. This includes maternal fever (≥39 °C or ≥38 °C for 30 min) associated with fetal tachycardia (>160 beats per minute –bpm- for ≥10 min), maternal leukocytosis (WBC >15,000/mm3), or purulent discharge from the cervical os. These parameters are sufficient to make the diagnosis of clinical chorioamnionitis, which should be confirmed by microbiological cultures and placental histopathology [36]. In the placenta we examined, chorioamnionitis was evident, but there was no intervillositis. This is usually associated with maternal sepsis due to group A Streptococci or other organisms such as Listeria monocytogenes, Campylobacter fetus, Francisella tularensis, and Brucella abortus [37]. Intervillositis may also be found as a consequence of bacterial spillover in the intervillous space from fetal capillaries, but fetal sepsis usually coexists [38].
Torsade de pointe due to QT prolongation following erythromycin administration in a preterm infant
Published in Acta Cardiologica, 2022
Caroline Fobe, Benedicte Van Grambezen, Stéphane Moniotte, Christophe Vo, Anneliese Dussart, Olivier Danhaive, Fiammetta Piersigilli
A 1600 grams male neonate was delivered by urgent caesarean section at 29 weeks’ gestation for maternal bleeding. The mother had a preterm premature rupture of membrane at 22 weeks of gestation and the vaginal culture was positive for Streptococcus agalactiae and Ureaplasma spp. At birth the Apgar score was 5 and 7 at 1 and 5 min respectively. The baby was intubated at 4 min of life and a dose of 200 mg/kg Surfactant was administered. He was ventilated on High Frequency Oscillation Ventilation (HFOV) due to his worsening clinical conditions and Nitric Oxyde (NO) and inotropes (noradrenaline and dobutamine) were started due to evidence of pulmonary hypertension. Intravenous (IV) antibiotic therapy was started immediately after birth with amoxicillin and amikacin for suspected chorioamnionitis. IV erythromycin was added based on the antibiogram of the maternal vaginal culture, positive for Ureaplasma spp.