CHORIOAMNIONITIS: A HIDDEN

CAUSE OF NEONATAL DEATH

Professor David Woods

Neonatal Medicine Department
University of Cape Town, South
Africa
 Process of colonization

• Ascending spread from vagina and cervix

• Bacteria – usually anaerobic
• Dilated cervix to expose membranes
• Colonization of chorion and amnion
• Spread to placenta
• Colonization of amniotic fluid
• Colonization or infection of fetus
 Why not transplacental?

• Classic twin study:

– Often first twin only
– Sometimes both twins
– Never second twin only

• Respiratory distress in twins:

– Twin A gets congenital pneumonia
– Twin B has pulmonary immaturity
 Bacterial vaginosis

• Deranged vaginal flora

• Lactobacillus replaced
• Gardnerella, Bacteroides
• Pathogens
• Discharge, itch and fishy smell
• Alkaline pH on litmus testing
• Clue cells: bacteria coated epithelial cells
• Metronidazole or clindamycin
• Normalise vaginal flora
 Dangers of chorioamnionitis

• Initiate preterm labour or prelabour rupture

of the membranes

• Chorioamnionitis leading to placentitis with

villous oedema

• Amnionitic fluid colonisation with fetal

infection
Acute inflammatory response
in the placenta

Mild: Maternal response below the

chorion only

Moderate: Maternal response

involving the chorion

Severe: Fetal response with vasculitis

Management of chorioamnionitis

• Promote normal vaginal flora

• Role of antibiotics

• Prophylaxis in the mother

• Diagnosis at birth

• Treatment in the newborn infant