Management of Clinical Chorioamnionitis: An Evidence-based Approach

Abstract

(Am J Obstet Gynecol. 2020;223:848–869) Clinical chorioamnionitis affects 1% to 6% of US pregnancies and is a risk factor for postpartum hemorrhage, neonatal sepsis, neonatal intensive care unit admission, neonatal death, and other adverse outcomes. Clinical chorioamnionitis has typically been diagnosed by maternal fever combined with at least 2 other symptoms: maternal tachycardia, fetal tachycardia, uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, or maternal leukocytosis. This condition is usually treated with antibiotics and antipyretic agents, along with expedited delivery, though management regimens vary widely in terms of types of antibiotic and timing of treatment. This review aimed to examine evidence on the treatment of clinical chorioamnionitis to develop an evidence-based management approach. A literature search was conducted using MEDLINE, EMBASE, POPLINE, LILACS, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial registries, and Google Scholar.