List of Abbreviations
CS – Cesarean section
PTL – Preterm labor
PPROM – Preterm premature rupture of membranes
RDS – respiratory distress syndrome
US – ultrasound examination
CA – Chorioamnionitis
Terms and Definitions
Chorioamnionitis (CA) is an infectious inflammation of the fetal membranes, amniotic fluid, decidua, and the fetus caused by polymicrobial associations [1–4].
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Chorioamnionitis is an infectious inflammation of the fetal membranes, amniotic fluid, decidua, and the fetus caused by polymicrobial associations.
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
CA is most common in preterm premature rupture of membranes (PPROM), but can also occur with intact membranes [5–14, 129]. Direct causative agents of CA may include group B streptococci, Peptostreptococci, staphylococci, Escherichia coli, mycoplasmas, ureaplasmas, enterococci, Chlamydia, Trichomonas, gonococci, Gardnerella, Candida, Bacteroides, herpes simplex virus, cytomegalovirus, etc. [15]. The pathogens most frequently detected in the amniotic fluid of women with clinical CA are Ureaplasma urealyticum, Gardnerella vaginalis, Mycoplasma hominis, Streptococcus agalactiae, Bacteroides and certain Lactobacillus species [5–14, 129]. Polymicrobial invasion of the amniotic cavity is present in approximately 50% of cases [5, 6, 11, 12].
Ascending microbial invasion from the lower genital tract is the most frequent pathway for the development of intra-amniotic infection [9, 12, 16–18, 129]. Hematogenous dissemination occurs rarely from chronic foci of infection [9, 12, 18–22]. Infectious agents trigger an inflammatory response in the mother and fetus, characterized by the release of a combination of pro-inflammatory and inhibitory cytokines and chemokines [23–25]. The inflammatory response may lead to the release of prostaglandins, cervical ripening, PPROM, and preterm labor (PTL) or term labor [15, 26, 27].
Prolonged rupture of membranes is the primary structural cause of CA: a duration of ≥12 hours increases the risk of CA by 5.8 times, and a duration of ≥18 hours by 6.9 times. A duration of labor of ≥12 hours increases the risk of CA by 4 times, a second stage of labor lasting ≥2 hours by 3.7 times, ≥3 vaginal examinations during labor with ruptured membranes by 2–5 times, group B streptococcus colonization by 1.7–7.2 times, and bacterial vaginosis by 1.7 times [28–33].
Neonates born to mothers with CA are at high risk for neonatal sepsis [34–41], bronchopulmonary dysplasia [42, 43], intraventricular hemorrhage [26, 37, 44], periventricular leukomalacia [33, 43–45], and neonatal death [39, 46, 47]. Evidence regarding the link between CA, cerebral palsy, and other nervous system disorders is contradictory: some studies report such an association [15, 26, 39, 48–50], while other studies do not confirm it [49, 51–54].
1.3 Epidemiology of the Disease or Condition
CA develops in 1–6% of all pregnancies [47, 55, 56, 129], 1–13% of term spontaneous deliveries, and 40–70% of preterm labor with PPROM [46, 57–61].
CA leads to an increased risk of Cesarean section (CS), postpartum hemorrhage due to uterine atony [34, 59], uterine rupture [56], blood component transfusion [34, 47, 56, 60], endomyometritis, wound infection, pelvic abscess, pelvic septic thrombophlebitis, and sepsis [34, 61–64]. 15% of CA cases are diagnosed during pregnancy and 85% during labor [60].
1.4 Features of Coding the Disease or Condition
O41.1 Infection of amniotic cavity and fetal membranes
1.5 Classification of the disease or condition
Classification of CA depending on the verification method [4, 65, 66]:
· CA diagnosed on the basis of clinical presentation;
· CA confirmed by histological examination of the placenta and/or microbiological (culture) examination of female genital tract discharge (and/or amniotic fluid) for aerobic and facultatively anaerobic microorganisms.
Classification of CA depending on pathogenesis [67]:
· ascending – from the lower genital tract;
· hematogenous – from chronic maternal infection foci;
· iatrogenic – bacterial invasion of amniotic fluid during invasive diagnostic or therapeutic procedures.
1.6 Clinical presentation of the disease or condition
The main symptoms of CA in any combination include febrile fever (body temperature ≥38.0°C), maternal tachycardia (≥100 bpm), fetal tachycardia (≥160 bpm), purulent or mucopurulent vaginal discharge, sometimes with a foul odor [29, 129].
Aside from objective signs such as fever and maternal/fetal tachycardia, other signs of CA are highly subjective. A foul odor of vaginal discharge is observed in only 4–25% of CA cases [29].
2. Diagnostics, medical indications and contraindications for diagnostic methods
CA is diagnosed in the presence of febrile fever and 2 of the following signs: fetal tachycardia (>160 bpm), maternal tachycardia, maternal leukocytosis (>15×10⁹/L in the absence of corticosteroid use), purulent or mucopurulent vaginal discharge
CA is verified on the basis of histological examination of the placenta and/or microbiological (culture) examination of female genital tract discharge (and/or amniotic fluid) for aerobic and facultatively anaerobic microorganisms [1, 3, 4, 68, 69].
2.1 Complaints and Anamnesis
It is recommended to take a patient history to check for complaints of elevated body temperature ≥38.0 °C, tachycardia, purulent or mucopurulent vaginal discharge, and foul-smelling vaginal discharge in order to diagnose CA [29].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
It is recommended to take into account risk factors for CA development in order to diagnose CA [14–17].
GPP CLOE 4Grade of Recommendation C (Level of Evidence – 4).
Comment. Risk factors for CA include acute and chronic infectious and inflammatory diseases; obstetric invasive diagnostic or therapeutic procedures.
It is recommended to determine gestational age and estimated date of delivery based on the last menstrual period and fetal ultrasound data (optimally – first-trimester ultrasound) in order to determine further management tactics [70, 71].
GSI ALoE 4Grade of Recommendation A (Level of Evidence – 4).
2.2 Physical Examination
It is recommended to perform general thermometry to detect hyperthermia [49, 64, 65, 72–75].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
Comment. Thermometry should be performed every 4 hours.
In patients who are not in labor, examination of the cervix and the nature of genital tract discharge using a sterile speculum is recommended [49, 76, 77].
GCR BLEL 4Grade of Recommendation B (Level of Evidence – 4).
If there are complaints of crampy lower abdominal pain, a vaginal examination to assess the condition of the birth canal is recommended only after ruling out placenta previa (via ultrasound) and prolapse/rupture of fetal membranes (via speculum examination of the cervix and, if necessary, an amniotic fluid leakage test) [49, 66, 72].
GSI CLoE 5Grade of Recommendation C (Level of Evidence – 5).
Comment. In the absence of active labor or onset of preterm labor, and in cases of PPROM without labor, vaginal examination should be avoided as it provides no additional crucial information but increases the risk of ascending infection [72, 77].
Measurement of peripheral blood pressure and the patient's heart rate is recommended to detect arterial hypertension/hypotension and tachycardia [49, 64, 65, 72–75].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
Auscultation of the fetal heart rate is recommended to assess the fetal condition [49, 64, 65, 72–75].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
2.3 Laboratory Diagnostics
· Determination of main blood groups by the ABO system and the D antigen of the Rh system (Rh factor) is recommended to prepare for potential blood transfusion [66, 77].
GCR CLOE 5Grade of Recommendation C (Level of Evidence – 5).
· Testing for IgM and IgG antibodies to human immunodeficiency virus (HIV-1/2) and p24 antigen (Human immunodeficiency virus HIV 1/2 + Agp24) in blood, antibodies to Treponema pallidum in blood, hepatitis B virus surface antigen (HBsAg) in blood, and total IgM and IgG antibodies (anti-HCV IgG and anti-HCV IgM) to hepatitis C virus (Hepatitis C virus) in blood is recommended for timely prevention of vertical transmission if not performed within the last 3 months [66, 77].
GSI CLoE 5Grade of Recommendation C (Level of Evidence – 5).
· A complete blood count (CBC) with differential is recommended to diagnose CA [49, 64, 65, 72–75].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. One of the signs of CA is leukocytosis >15×10⁹/L [49, 64, 65, 72–75]. The test is performed once every 12 hours until delivery to monitor the course of CA.
· Determination of serum C-reactive protein level is recommended to diagnose CA [49, 78, 79].
GCR BLOE 2Grade of Recommendation B (Level of Evidence – 2).
Comment. A sign of CA is a C-reactive protein level >5 mg/L [66, 81, 82]. The test is performed once every 12 hours until delivery to monitor the course of CA.
· Microbiological (culture) examination of female genital tract discharge for aerobic and facultatively anaerobic microorganisms is recommended to verify the diagnosis of CA [49, 64, 65, 72–75].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. A sign of CA is the presence of pathogens and/or opportunistic flora concentration >10⁵ CFU/mL [49, 64, 65, 72–75]. This test is performed once regardless of amniotic fluid leakage.
· Pathological examination of the placenta is recommended to verify the diagnosis of CA [49, 64, 65, 72–75].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. A sign of CA is the presence of inflammatory signs in the membranes and placenta [49, 64, 65, 72–75].
· In case of PPROM, identification of amniotic fluid leakage via speculum examination of the cervix or an amniotic fluid leakage test is recommended [80].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
Comment. Rapid laboratory tests include the cytological test (ferning test, false-negative rate >20%), nitrazine test (false-positive rate 5–30%), and tests for insulin-like growth factor-binding protein 1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) [81–83].
2.4 Instrumental Diagnostics
· Fetal cardiotocography is recommended to assess the fetal condition [2, 74, 84].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
· Fetal ultrasound is recommended for fetometry, assessment of fetal position and presentation [2, 74, 84].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
2.5 Other Procedures
· Consultation with an anesthesiologist-resuscitologist is recommended to assess intraoperative risks in the event of operative delivery via CS [1, 85].
Level CLevel 5Level of recommendation evidence C (reliability level of evidence – 5).
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1. Non-pharmacological therapy.
Not applicable.
3.2. Pharmacotherapy.
· Antibacterial therapy is recommended to reduce neonatal morbidity and purulent-septic maternal complications [4, 80, 86–91].
GSI ALoE 1Grade of Recommendation A (Level of Evidence – 1).
Comments. The drugs of choice are #ampicillin** or #cefazolin** combined with #gentamicin**. Regimens: (1) #ampicillin** 2 g intravenously every 6 h + #gentamicin** 5 mg/kg intravenously every 24 h or 2 mg/kg followed by 1.5 mg/kg every 8 h; (2) #cefazolin** 2 g intravenously every 8 h + #gentamicin** 5 mg/kg every 24 h or 2 mg/kg followed by 1.5 mg/kg every 8 h. For monotherapy, ampicillin + [sulbactam]** 1.5 g intravenously every 6 h is prescribed. Second- to third-generation cephalosporins are also prescribed for monotherapy: #cefoxitin** 2 g intravenously every 8 h or ceftriaxone** 1 g every 24 h; in severe cases, the daily dose can be increased up to 4 g [4, 68, 75, 86–89]. In case of an allergic reaction to penicillins, #clindamycin** or #vancomycin** combined with #gentamicin** is recommended. Regimen: #clindamycin** 900 mg intravenously every 8 h or #vancomycin** 1 g intravenously every 12 h + #gentamicin** 5 mg/kg intravenously every 24 h or 2 mg/kg followed by 1.5 mg/kg every 8 h [4, 68, 75, 86–89].
· During delivery by Cesarean section, administration of an additional dose of #clindamycin** 900 mg intravenously or #metronidazole** 500 mg intravenously is recommended to reduce purulent-septic complications in the mother [88–92].
GR BLE 2Grade of Recommendation B (Level of Evidence – 2).
· Discontinuation of antibiotic therapy in the postpartum period is recommended in the absence of clinical manifestations of endometritis for 24 h [91, 93].
GR ALE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. A meta-analysis of various studies showed no significant difference in the rate of obstetric complications between groups receiving antibiotics and placebo in the postpartum period.
· Prescription of paracetamol** is recommended to manage febrile fever [95–105].
GR BLE 2Grade of Recommendation B (Level of Evidence – 2).
Comments. Fever during labor can lead to fetal tachycardia [97, 98], operative vaginal delivery [94–96], Cesarean section [96, 99], neonatal encephalopathy [100, 101], ischemic stroke [102], and neonatal seizures [76, 103]. Administration of antipyretic drugs to patients with fever can reduce adverse obstetric and neonatal outcomes. Paracetamol** is the safest antipyretic agent during pregnancy [68, 104, 105]. The single oral dose of paracetamol** is 500 mg every 4–6 h, and the total daily dose should not exceed 4 g [106, 107]. Paracetamol** can be administered orally, rectally, or intravenously. When administered intravenously, the maximum concentration of paracetamol** in the blood is reached within 15 minutes, which increases its bioavailability in all tissues in the shortest possible time [107, 108].
· Intravenous administration of #magnesium sulfate** at 240–336 weeks of gestation is recommended for fetal neuroprotection [109–111][1].
GR ALE 1Grade of Recommendation A (Level of Evidence – 1).
Comments. The use of #magnesium sulfate** 24 hours before delivery reduces the incidence of cerebral palsy and motor disorders in the fetus. The maximum effect is observed up to 306 weeks [109–111]. The use of magnesium sulfate** is contraindicated in patients with myasthenia gravis and cardiac conduction disorders. In patients with impaired renal function, the dose of #magnesium sulfate** must be adjusted individually. Administration regimen: a loading dose of 4 g over 20–30 minutes, then 1 g/h for 24 h intravenously. It is not recommended to delay delivery for the purpose of administering a full course of magnesium sulfate** [4].
· It is recommended to consider antenatal prevention of fetal respiratory distress syndrome at 240–336 weeks of gestation [4, 94, 107–109][2].
GCR CLEL 3Level of recommendation evidence C (level of data reliability – 3).
Comments. The use of glucocorticosteroids in patients with chorioamnionitis remains controversial given their immunosuppressive effect, which can activate infection and increase the risk of septic complications for the mother and fetus. Nevertheless, newborns born to patients with chorioamnionitis who received even an incomplete course of glucocorticosteroids had a significantly lower risk of death and/or other adverse neonatal outcomes [4, 94, 107–109] without an increased risk of sepsis or other adverse neonatal outcomes. At the same time, it is not recommended to delay delivery for the purpose of administering a full course of fetal respiratory distress syndrome prevention.
3.3. Delivery.
· It is recommended to consider delivery regardless of gestational age to reduce the risk of obstetric and perinatal complications [5, 23, 37, 119–122].
GR ALE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. The choice of delivery method and its execution must be performed within 24 h.
· Continuous fetal cardiotocography monitoring during labor is recommended to monitor fetal status [118–121].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5).
Comment. Signs of chorioamnionitis include fetal tachycardia (heart rate over 160 beats per minute) and absence of accelerations during labor [118–121], although neither sign is associated with an increased risk of adverse neonatal or infant outcomes.
· Vaginal delivery (induction of labor or labor augmentation) is recommended in the absence of indications for abdominal delivery by Cesarean section to reduce the risk of septic obstetric complications [5, 23, 37, 119–122].
GR ALE 2Grade of Recommendation A (Level of Evidence – 2).
Comment. Women receiving antibiotic therapy did not show a correlation between the duration of labor and adverse neonatal outcomes; therefore, Cesarean section to shorten the duration of labor is not recommended. Delivery via Cesarean section increases the risk of wound infection, endometritis, and venous thromboembolism.
· In preterm rupture of membranes, Cesarean section is not recommended as the method of choice for delivery [60].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
Comments. There is an equal incidence of birth trauma, birth asphyxia, and perinatal mortality between Cesarean section and vaginal delivery, but higher maternal morbidity with Cesarean section compared to vaginal delivery. At the same time, a number of studies have shown that at 24–27 weeks of gestation, Cesarean section is preferred as it is associated with a lower incidence of severe neonatal complications [122]. If the estimated fetal weight does not correspond to the gestational age, Cesarean section is preferred at less than 31 weeks. When the estimated fetal weight corresponds to gestational age, vaginal delivery at 32–33 weeks has more favorable neonatal outcomes compared to Cesarean section [123].
· In preterm birth and fetal breech presentation up to 32 weeks of gestation, Cesarean section is recommended as the method of choice for delivery [124, 125].
Level of Evidence BLevel of Confidence 2Level of recommendation B (level of evidence – 2).
Comments. The method of delivery should be individualized depending on the stage of labor, type of breech presentation, fetal condition, and availability of a physician skilled in breech delivery techniques. In a favorable obstetric situation, preterm breech delivery is possible [126]. At a gestational age of less than 27 weeks, delivery via Cesarean section is associated with a lower incidence of neonatal mortality and severe intraventricular hemorrhage [127]. If technical capabilities are available, delivery of the fetus within the intact amniotic membranes is recommended.
· Induction of labor by intravenous infusion of oxytocin** or labor augmentation is recommended in case of labor dystocia [56, 57, 115–118].
GR BLE 3Grade of Recommendation B (Level of Evidence – 3).
Comment. Patients with chorioamnionitis more frequently exhibit uterine dyscoordination and labor dystocia [56, 57, 115–118]. Bacteria causing chorioamnionitis affect myometrial contractility by reducing the sensitivity of myometrial receptors to oxytocin [128].
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[2] https://disk.yandex.ru/i/DzdPmpqt1o7IFA
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
· It is recommended to refer the pregnant patient for group B streptococcus (S. agalactiae) antigen testing in cervical canal discharge at 360–376 weeks of gestation for timely treatment [129–131].
GGR BLOC 1Grade of Recommendation B (Level of Evidence – 1).
· It is recommended to refer the pregnant patient for microscopic examination of vaginal smears at the 1st visit and in the 3rd trimester of pregnancy for timely treatment [49, 132–134].
GPP BLOE 3Grade of Recommendation B (Level of Evidence – 3).
Comment. This test may be recommended if there are complaints of vaginal discomfort, changes in the nature of vaginal discharge, itching, burning, foul-smelling discharge, or inflammatory findings on microscopic smear examination. Timely treatment of vaginal bacterial flora disorders reduces the risk of infectious complications.
· It is recommended to refer pregnant patients for a single microbiological (culture) examination of a midstream urine sample for bacterial pathogens to detect asymptomatic bacteriuria at the 1st visit in order to provide timely treatment [135].
GPP ALOE 1Grade of Recommendation A (Level of Evidence – 1).
Comment. Asymptomatic bacteriuria is the detection of bacteria in a diagnostically significant titer in two consecutive microbiological (culture) examinations of a voided midstream urine sample (taken no more than 14 days apart) in the absence of clinical symptoms. Early detection of bacteriuria and timely therapy reduce the risk of infectious complications.
· In preterm premature rupture of membranes (PPROM) at a gestational age of less than 36 weeks, antibiotic therapy is recommended to prolong pregnancy and prevent chorioamnionitis [136].
GCR ALoE 2Grade of Recommendation A (Level of Evidence – 2).
Comments. Scientifically proven and confirmed drugs are #ampicillin** 2 g intravenously every 6 hours for 48 hours, and #amoxicillin** 250 mg every 8 hours for 5 days or #erythromycin** 250 mg every 6 hours for a maximum of up to 10 days. The use of systemic antibacterial drugs is associated with a significant reduction in the rate of chorioamnionitis, neonatal infection, and perinatal mortality [78, 136, 137]. The decision on a repeated course of antibiotic therapy is made based on the results of infectious and inflammatory monitoring.
6. Organization of Medical Care
Patients with chorioamnionitis should be hospitalized in a level 2 or level 3 obstetric healthcare facility depending on the gestational age.
7. Additional Information
Not applicable.
Criteria for Evaluating the Quality of Medical Care
№ | Quality criteria | Performance assessment (yes/no) |
|---|---|---|
1. | The gestational age and expected date of delivery were determined based on the last menstrual period and fetal ultrasound data. | Yes/no |
2. | A blood leukocyte count and a serum C-reactive protein level test were performed. | Yes/no |
3. | A microbiological (culture) analysis of female genital discharge for aerobic and facultatively anaerobic microorganisms was performed. | Yes/no |
4. | Delivery within 24 hours after diagnosis | Yes/no |
5. | Pathological examination of the placenta was performed | Yes/no |
6. | Antibiotic therapy was administered | Yes/no |
References
Show references
1. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019; 133(3):e208–25.
2. Tita A.T.N., Andrews W.W. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010; 37(2):339–54.
3. Schmitz T., Sentilhes L., Lorthe E., Gallot D., Madar H., Doret-Dion M., et al. [Preterm premature rupture of membranes: CNGOF Guidelines for clinical practice - Short version]. Gynecol Obstet Fertil Senol. 2018; 46(12):998–1003.
4. Conde-Agudelo A., Romero R., Jung E.J., Garcia Sánchez Á.J. Management of clinical chorioamnionitis: an evidence-based approach [Internet]. Vol. 223, American Journal of Obstetrics and Gynecology. Elsevier Inc.; 2020. 848–869 p.
5. Romero R., Chaemsaithong P., Korzeniewski S.J., Kusanovic J.P., Docheva N., Martinez-Varea A., et al. Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection? J Perinat Med. 2016; 44(1):23–32.
6. Oh K.J., Kim S.M., Hong J.-S., Maymon E., Erez O., Panaitescu B., et al. Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation. Am J Obstet Gynecol. 2017; 216(6):604.e1-604.e11.
7. Kikhney J., von Schöning D., Steding I., Schulze J., Petrich A., Hiergeist A., et al. Is Ureaplasma spp. the leading causative agent of acute chorioamnionitis in women with preterm birth? Clin Microbiol Infect. 2017; 23(2):119.e1-119.e7.
8. Oh K.J., Romero R., Park J.Y., Hong J.-S., Yoon B.H. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species. J Perinat Med. 2019; 47(5):516–27.
9. Romero R., Gomez-Lopez N., Kusanovic J.P., Pacora P., Panaitescu B., Erez O., et al. Clinical Chorioamnionitis at Term: New Insights into the Etiology, Microbiology, and the Fetal, Maternal and Amniotic Cavity Inflammatory Responses. Nogyogy es szuleszeti Tovabbk Szle. 2018; 20(3):103–12.
10. Sweeney E.L., Dando S.J., Kallapur S.G., Knox C.L. The human Ureaplasma species as causative agents of chorioamnionitis. Clin Microbiol Rev. 2017; 30(1):349–79.
11. Combs C.A., Gravett M., Garite T.J., Hickok D.E., Lapidus J., Porreco R., et al. Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes. Am J Obstet Gynecol. 2014; 210(2):125.e1-125.e15.
12. Mendz G.L., Kaakoush N.O., Quinlivan J.A. Bacterial aetiological agents of intra-amniotic infections and preterm birth in pregnant women. Front Cell Infect Microbiol. 2013; 3:58.
13. Oh K.J., Lee K.A., Sohn Y.-K., Park C.-W., Hong J.-S., Romero R., et al. Intraamniotic infection with genital mycoplasmas exhibits a more intense inflammatory response than intraamniotic infection with other microorganisms in patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 2010; 203(3):211.e1-8.
14. Krohn M.A., Hillier S.L., Nugent R.P., Cotch M.F., Carey J.C., Gibbs R.S., et al. The genital flora of women with intraamniotic infection. Vaginal Infection and Prematurity Study Group. J Infect Dis. 1995; 171(6):1475–80.
15. Freud A., Wainstock T., Sheiner E., Beloosesky R., Fischer L., Landau D., et al. Maternal chorioamnionitis & long term neurological morbidity in the offspring. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc. 2019; 23(3):484–90.
16. Romero R., Gomez-Lopez N., Winters A.D., Jung E., Shaman M., Bieda J., et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019; 47(9):915–31.
17. Kim M.J., Romero R., Gervasi M.T., Kim J.-S., Yoo W., Lee D.-C., et al. Widespread microbial invasion of the chorioamniotic membranes is a consequence and not a cause of intra-amniotic infection. Lab Invest. 2009; 89(8):924–36.
18. Kim C., Romero R., Chaemsaithong P., Chaiyasit N., Yoon B., Kim Y. Acute Chorioamnionitis and Funisitis: Definition, Pathologic Features, and Clinical Significance. Am J Obstet Gynecol. 2015; 213:S29–52.
19. Sorano S., Goto M., Matsuoka S., Tohyama A., Yamamoto H., Nakamura S., et al. Chorioamnionitis caused by Staphylococcus aureus with intact membranes in a term pregnancy: A case of maternal and fetal septic shock. J Infect Chemother Off J Japan Soc Chemother. 2016; 22(4):261–4.
20. Jadhav A.R., Belfort M.A., Dildy G.A. 3rd. Eikenella corrodens chorioamnionitis: modes of infection? Am J Obstet Gynecol. 2009; 200(5):e4-5.
21. Radochova V., Musilova I., Stepan M., Vescicik P., Slezák R., Jacobsson B., et al. Periodontal disease and intra-amniotic complications in women with preterm prelabor rupture of membranes. J Matern Neonatal Med. 2017; 31:1.
22. Tongsong T., Wanapirak C., Kunavikatikul C., Sirirchotiyakul S., Piyamongkol W., Chanprapaph P. Cordocentesis at 16-24 weeks of gestation: experience of 1,320 cases. Prenat Diagn. 2000; 20(3):224–8.
23. Goldenberg R.L., Andrews W.W., Hauth J.C. Choriodecidual infection and preterm birth. Nutr Rev. 2002; 60(5 Pt 2):S19-25.
24. Fahey J.O. Clinical management of intra-amniotic infection and chorioamnionitis: a review of the literature. J Midwifery Womens Health. 2008; 53(3):227–35.
25. Romero R., Chaemsaithong P., Korzeniewski S.J., Tarca A.L., Bhatti G., Xu Z., et al. Clinical chorioamnionitis at term II: The intra-amniotic inflammatory response. J Perinat Med. 2016; 44(1):5–22.
26. Xing L., Wang G., Chen R., Ren J., Qian J., Huang Y. Is chorioamnionitis associated with neurodevelopmental outcomes in preterm infants? A systematic review and meta-analysis following PRISMA. Med (United States). 2019; 98(50).
27. Sato M., Nishimaki S., Yokota S., Seki K., Horiguchi H., An H., et al. Severity of chorioamnionitis and neonatal outcome. J Obstet Gynaecol Res. 2011; 37(10):1313–9.
28. Soper D.E., Mayhall C.G., Dalton H.P. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol. 1989; 161(3):562–8.
29. Newton E.R. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol. 1993; 36(4):795–808.
30. NEWTON E.D., PRIHODA T.J., GIBBS R.S. Logistic Regression Analysis of Risk Factors for Intra-Amniotic Infection. Obstet Gynecol. 1989; 73(4).
31. Piper J.M., Newton E.R., Berkus M.D., Peairs W.A. Meconium: a marker for peripartum infection. Obstet Gynecol. 1998; 91(5 Pt 1):741–5.
32. Seaward P.G., Hannah M.E., Myhr T.L., Farine D., Ohlsson A., Wang E.E., et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997; 177(5):1024–9.
33. Romero-Guzman G.J., Lopez-Munoz F. [Prevalence and risk factors for periventricular leukomalacia in preterm infants. A systematic review]. Rev Neurol. 2017; 65(2):57–62.
34. Rouse D.J., Landon M., Leveno K.J., Leindecker S., Varner M.W., Caritis S.N., et al. The maternal-fetal medicine units cesarean registry: Chorioamnionitis at term and its duration - Relationship to outcomes. Am J Obstet Gynecol. 2004; 191(1):211–6.
35. Randis T.M., Rice M.M., Myatt L., Tita A.T.N., Leveno K.J., Reddy U.M., et al. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med. 2018; 46(8):926–33.
36. Venkatesh K.K., Jackson W., Hughes B.L., Laughon M.M., Thorp J.M., Stamilio D.M. Association of chorioamnionitis and its duration with neonatal morbidity and mortality. J Perinatol. 2019; 39(5):673–82.
37. Soraisham A.S., Singhal N., McMillan D.D., Sauve R.S., Lee S.K. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol. 2009; 200(4):372.e1-6.
38. Klinger G., Levy I., Sirota L., Boyko V., Reichman B., Lerner-Geva L. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol. 2009; 201(1):38.e1-6.
39. Pappas A., Kendrick D.E., Shankaran S., Stoll B.J., Bell E.F., Laptook A.R., et al. Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates. JAMA Pediatr. 2014; 168(2):137–47.
40. Ericson J.E., Laughon M.M. Chorioamnionitis: implications for the neonate. Clin Perinatol. 2015; 42(1):155–65, ix.
41. Gowda H., Norton R., White A., Kandasamy Y. Late-onset Neonatal Sepsis-A 10-year Review From North Queensland, Australia. Pediatr Infect Dis J. 2017; 36(9):883–8.
42. Villamor-Martinez E., Álvarez-Fuente M., Ghazi A.M.T., Degraeuwe P., Zimmermann L.J.I., Kramer B.W., et al. Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review, Meta-analysis, and Metaregression. JAMA Netw open. 2019; 2(11):e1914611.
43. Wang L.-W., Lin Y.-C., Wang S.-T., Huang C.-C. Identifying Risk Factors Shared by Bronchopulmonary Dysplasia, Severe Retinopathy, and Cystic Periventricular Leukomalacia in Very Preterm Infants for Targeted Intervention. Neonatology. 2018; 114(1):17–24.
44. Spiegel A.M., Li J., Oehlert J.W., Mayo J.A., Quaintance C.C., Girsen A.I., et al. A Genome-Wide Analysis of Clinical Chorioamnionitis among Preterm Infants. Am J Perinatol. 2019; 36(14):1453–8.
45. García-Muñoz Rodrigo F., Galán Henríquez G.M., Ospina C.G. Morbidity and mortality among very-low-birth-weight infants born to mothers with clinical chorioamnionitis. Pediatr Neonatol. 2014; 55(5):381–6.
46. Seong H.S., Lee S.E., Kang J.H., Romero R., Yoon B.H. The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor. Am J Obstet Gynecol. 2008; 199(4):375.e1-5.
47. Racusin D.A., Chen H.-Y., Bhalwal A., Wiley R., Chauhan S.P. Chorioamnionitis and adverse outcomes in low-risk pregnancies: a population-based study. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021; :1–9.
48. Wu Y.W., Escobar G.J., Grether J.K., Croen L.A., Greene J.D., Newman T.B. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA. 2003; 290(20):2677–84.
49. Schmitz T., Sentilhes L., Lorthe E., Gallot D., Madar H., Doret-Dion M., et al. Management of clinical chorioamnionitis: an evidence-based approach. Crowther CA, editor. Am J Obstet Gynecol. 2017; 221(1):1–6.
50. Xiao D., Zhu T., Qu Y., Gou X., Huang Q., Li X., et al. Maternal chorioamnionitis and neurodevelopmental outcomes in preterm and very preterm neonates: A meta-analysis. PLoS One. 2018; 13(12):e0208302.
51. Maisonneuve E., Ancel P.-Y., Foix-L’Hélias L., Marret S., Kayem G. Impact of clinical and/or histological chorioamnionitis on neurodevelopmental outcomes in preterm infants: A literature review. J Gynecol Obstet Hum Reprod. 2017; 46(4):307–16.
52. Vander Haar E., Gyamfi-Bannerman C. Chorioamnionitis and Neurocognitive Development at Age 2 Years. Obstet Gynecol. 2016; 127(3):437–41.
53. Shi Z., Ma L., Luo K., Bajaj M., Chawla S., Natarajan G., et al. Chorioamnionitis in the Development of Cerebral Palsy: A Meta-analysis and Systematic Review. Pediatrics. 2017; 139(6).
54. Ylijoki M.K., Ekholm E., Ekblad M., Lehtonen L. Prenatal Risk Factors for Adverse Developmental Outcome in Preterm Infants-Systematic Review. Vol. 10, Frontiers in psychology. 2019. p. 595.
55. Bommarito K.M., Gross G.A., Willers D.M., Fraser V.J., Olsen M.A. The Effect of Clinical Chorioamnionitis on Cesarean Delivery in the United States. Health Serv Res. 2016; 51(5):1879–95.
56. Perry A., Rossi R., Defranco E. Severe Adverse Maternal Outcomes Associated with Chorioamnionitis. Am J Obstet Gynecol MFM. 2019; 1.
57. Alexander J.M., McIntire D.M., Leveno K.J. Chorioamnionitis and the prognosis for term infants. Obstet Gynecol. 1999; 94(2):274–8.
58. Blume H.K., Li C.I., Loch C.M., Koepsell T.D. Intrapartum fever and chorioamnionitis as risks for encephalopathy in term newborns: A case-control study. Dev Med Child Neurol. 2008; 50(1):19–24.
59. Rouse D.J., Leindecker S., Landon M., Bloom S.L., Varner M.W., Moawad A.H., et al. The MFMU Cesarean Registry: uterine atony after primary cesarean delivery. Am J Obstet Gynecol. 2005; 193(3 Pt 2):1056–60.
60. Venkatesh K.K., Glover A. V, Vladutiu C.J., Stamilio D.M. Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study. BJOG. 2019; 126(6):719–27.
61. Witlin A.G., Mercer B.M., Sibai B.M. Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology. J Matern Fetal Med. 1996; 5(6):355–8.
62. Koh K.S., Chan F.H., Monfared A.H., Ledger W.J., Paul R.H. The changing perinatal and maternal outcome in chorioamnionitis. Obstet Gynecol. 1979; 53(6):730–4.
63. Romero R., Kadar N., Vaisbuch E., Hassan S.S. Maternal death following cardiopulmonary collapse after delivery: amniotic fluid embolism or septic shock due to intrauterine infection? Am J Reprod Immunol. 2010; 64(2):113–25.
64. Chebbo A., Tan S., Kassis C., Tamura L., Carlson R.W. Maternal Sepsis and Septic Shock. Crit Care Clin. 2016; 32(1):119–35.
65. Hospital Sant Joan de Déu. Protocolo: Corioamnionitis o triple I. Hosp Clin Barcelona. 2020; (1):1–7.
66. Gynecologists T. american college of obstetricians and. Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017; 130(2):e95–101.
67. Sidelnikova V.M., Sukhikh G.T. Miscarriage: A guide for practicing physicians. Moscow: Meditsinskoe informatsionnoe agentstvo LLC; 2011.
68. Tita A.T.N., Andrews W.W. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010; 37(2):339–54.
69. Savelyeva G.M., Sukhikh G.T., Serov V.N. Obstetrics. National Guidelines. 2018.
70. Savitz D.A., Terry J.W.J., Dole N., Thorp J.M.J., Siega-Riz A.M., Herring A.H. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol. 2002; 187(6):1660–6.
71. Olesen A.W., Thomsen S.G. Prediction of delivery date by sonography in the first and second trimesters. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2006; 28(3):292–7.
72. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2017; 130(2):e102–9.
73. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009; 114(1):192–202.
74. Johnson C.T., Farzin A., Burd I. Current management and long-term outcomes following chorioamnionitis. Obstet Gynecol Clin North Am. 2014; 41(4):649–69.
75. Beucher G., Charlier C., Cazanave C. Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines. Gynecol Obstet Fertil Senol. 2018; 46(12):1054–67.
76. Tuuli M.G., Macones G.A., Roehl K.A., Odibo A.O., Cahill A.G. Risk factors for serious morbidity in term nonanomalous neonates. Am J Obstet Gynecol. 2015; 212(6):799.e1-799.e7.
77. Alexander J.M., Mercer B.M., Miodovnik M., Thurnau G.R., Goldenberg R.L., Das A.F., et al. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet Gynecol. 2000; 183(4):1003–7.
78. NICE. Preterm labour and birth overview. Natl Inst Heal Care Excell. 2019; (August):1–12.
79. Sepsis - NICE. 2020; (July 2016).
80. Oláh K.S., Gee H. The prevention of preterm delivery--can we afford to continue to ignore the cervix? Br J Obstet Gynaecol. 1992; 99(4):278–80.
81. Ting H.-S., Chin P.-S., Yeo G.S.H., Kwek K. Comparison of bedside test kits for prediction of preterm delivery: phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) test and fetal fibronectin test. Ann Acad Med Singapore. 2007; 36(6):399–402.
82. Ehsanipoor R.M., Swank M.L., Jwa S.C., Wing D.A., Tarabulsi G., Blakemore K.J. Placental α-Microglobulin-1 in Vaginal Secretions of Women with Evidence of Preterm Labor. Am J Perinatol. 2016; 33(2):208–13.
83. Alfirevic Z., Allen-Coward H., Molina F., Vinuesa C.P., Nicolaides K. Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial. Ultrasound Obstet Gynecol. 2007; 29(1):47–50.
84. Popowski T., Goffinet F., Maillard F., Schmitz T., Leroy S., Kayem G. Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study. BMC Pregnancy Childbirth. 2011; 11:26.
85. Shmakov R.G., Baev O.R., Pekarev O.G., Pyregov A.V., Prikhodko A.M., Sidorova I.V. Cesarean section. Indications, surgical technique, pain management methods: study guide. IFP "System Solutions" LLC; 2014:72.
86. Higgins R.D., Saade G., Polin R.A., Grobman W.A., Buhimschi I.A., Watterberg K., et al. Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop. Vol. 127, Obstetrics and gynecology. 2016. p. 426–36.
87. Fishman S.G., Gelber S.E. Evidence for the clinical management of chorioamnionitis. Semin Fetal Neonatal Med. 2012; 17(1):46–50.
88. Lyell D.J., Pullen K., Fuh K., Zamah A.M., Caughey A.B., Benitz W., et al. Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: A randomized controlled trial. Obstet Gynecol. 2010; 115(2 PART 1):344–9.
89. Chapman E., Reveiz L., Illanes E., Cosp X.B. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014; 2014(12).
90. Edwards R.K., Duff P. Single additional dose postpartum therapy for women with chorioamnionitis. Obstet Gynecol. 2003; 102(5 Pt 1):957–61.
91. Shanks A.L., Mehra S., Gross G., Colvin R., Harper L.M., Tuuli M.G. Treatment Utility of Postpartum Antibiotics in Chorioamnionitis Study. Am J Perinatol. 2016; 33(8):732–7.
92. Alekwe L., Kuti O., Orji E., Ogunniyi S. Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities. J Matern Fetal Neonatal Med. 2008; 21:638–42.
93. Turnquest M.A., How H.Y., Cook C.R., O’Rourke T.P., Cureton A.C., Spinnato J.A., et al. Chorioamnionitis: is continuation of antibiotic therapy necessary after cesarean section? Am J Obstet Gynecol. 1998; 179(5):1261–6.
94. Ashwal E., Salman L., Tzur Y., Aviram A., Ben-Mayor Bashi T., Yogev Y., et al. Intrapartum fever and the risk for perinatal complications - the effect of fever duration and positive cultures. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2018; 31(11):1418–25.
95. Lieberman E., Cohen A., Lang J., Frigoletto F., Goetzl L. Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery. Am J Public Health. 1999; 89(4):506–10.
96. Dior U.P., Kogan L., Eventov-Friedman S., Gil M., Bahar R., Ergaz Z., et al. Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes. Neonatology. 2016; 109(1):62–8.
97. Burgess A.P.H., Katz J.E., Moretti M., Lakhi N. Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae. Gynecol Obstet Invest. 2017; 82(5):508–16.
98. Wang C., Schroeder I., Cazales A., Kim R., Albert A., Elwood C., et al. Management of fever in labor after institution of a standardized order set at a maternity quaternary care center. Am J Obstet Gynecol. 2019; 221:687.
99. Lange E.M.S., Segal S., Pancaro C., Wong C.A., Grobman W.A., Russell G.B., et al. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study. Anesthesiology. 2017; 127(6):942–52.
100. Kasdorf E., Perlman J.M. Hyperthermia, inflammation, and perinatal brain injury. Pediatr Neurol. 2013; 49(1):8–14.
101. Impey L.W.M., Greenwood C.E.L., Black R.S., Yeh P.S.-Y., Sheil O., Doyle P. The relationship between intrapartum maternal fever and neonatal acidosis as risk factors for neonatal encephalopathy. Am J Obstet Gynecol. 2008; 198(1):49.e1-6.
102. Li C., Miao J.K., Xu Y., Hua Y.Y., Ma Q., Zhou L.L., et al. Prenatal, perinatal and neonatal risk factors for perinatal arterial ischaemic stroke: a systematic review and meta-analysis. Eur J Neurol. 2017; 24(8):1006–15.
103. Greenwell E.A., Wyshak G., Ringer S.A., Johnson L.C., Rivkin M.J., Lieberman E. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics. 2012; 129(2):e447-54.
104. Johnson C.T., Adami R.R., Farzin A. Antibiotic therapy for chorioamnionitis to reduce the global burden of associated disease. Front Pharmacol. 2017; 8(MAR):1–6.
105. Hastings-Tolsma M., Bernard R., Brody M.G., Hensley J., Koschoreck K., Patterson E. Chorioamnionitis: Prevention and management. MCN Am J Matern Nurs. 2013; 38(4):206–12.
106. Nitsche J.F., Patil A.S., Langman L.J., Penn H.J., Derleth D., Watson W.J., et al. Transplacental Passage of Acetaminophen in Term Pregnancy. Am J Perinatol. 2017; 34(6):541–3.
107. Kirshon B., Moise K.J.J., Wasserstrum N. Effect of acetaminophen on fetal acid-base balance in chorioamnionitis. J Reprod Med. 1989; 34(12):955–9.
108. Holmér Pettersson P., Owall A., Jakobsson J. Early bioavailability of paracetamol after oral or intravenous administration. Acta Anaesthesiol Scand. 2004; 48(7):867–70.
109. Conde-Agudelo A., Romero R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks’ gestation: a systematic review and metaanalysis. Am J Obstet Gynecol. 2009; 200(6):595–609.
110. Doyle L.W., Crowther C.A., Middleton P., Marret S., Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane database Syst Rev. 2009; (1):CD004661.
111. Costantine M.M., Weiner S.J., Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Effects of antenatal exposure to magnesium sulfate on neuroprotection and mortality in preterm infants: a meta-analysis. Obstet Gynecol. 2009; 114(2 Pt 1):354–64.
112. Elimian A., Figueroa R., Spitzer A.R., Ogburn P.L., Wiencek V., Quirk J.G. Antenatal corticosteroids: are incomplete courses beneficial? Obstet Gynecol. 2003; 102(2):352–5.
113. Chawla S., Natarajan G., Shankaran S., Pappas A., Stoll B.J., Carlo W.A., et al. Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids. JAMA Pediatr. 2016; 170(12):1164–72.
114. Norman M., Piedvache A., Børch K., Huusom L.D., Bonamy A.-K.E., Howell E.A., et al. Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort. JAMA Pediatr. 2017; 171(7):678–86.
115. Duff P., Sanders R., Gibbs R.S. The course of labor in term patients with chorioamnionitis. Am J Obstet Gynecol. 1983; 147(4):391–5.
116. Satin A.J., Maberry M.C., Leveno K.J., Sherman M.L., Kline D.M. Chorioamnionitis: a harbinger of dystocia. Obstet Gynecol. 1992; 79(6):913–5.
117. Mark S.P., Croughan-Minihane M.S., Kilpatrick S.J. Chorioamnionitis and uterine function. Obstet Gynecol. 2000; 95(6 Pt 1):909–12.
118. Maberry M.C., Ramin S.M., Gilstrap L.C. 3rd, Leveno K.J., Dax J.S. Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection. Obstet Gynecol. 1990; 76(3 Pt 1):351–4.
119. Hauth J.C., Gilstrap L.C. 3rd, Hankins G.D., Connor K.D. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol. 1985; 66(1):59–62.
120. Sameshima H., Ikenoue T., Ikeda T., Kamitomo M., Ibara S. Association of nonreassuring fetal heart rate patterns and subsequent cerebral palsy in pregnancies with intrauterine bacterial infection. Am J Perinatol. 2005; 22(4):181–7.
121. Galli L., Dall’Asta A., Whelehan V., Archer A., Chandraharan E. Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses. J Obstet Gynaecol Res. 2019; 45(12):2343–50.
122. Simmons S.W., Dennis A.T., Cyna A.M., Richardson M.G., Bright M.R. Combined spinal-epidural versus spinal anaesthesia for caesarean section. Cochrane database Syst Rev. 2019; 10:CD008100.
123. Holzer I., Lehner R., Ristl R., Husslein P.W., Berger A., Farr A. Effect of delivery mode on neonatal outcome among preterm infants: an observational study. Wien Klin Wochenschr. 2017; 129(17–18):612–7.
124. Younge N., Goldstein R.F., Bann C.M., Hintz S.R., Patel R.M., Smith P.B., et al. Survival and Neurodevelopmental Outcomes among Periviable Infants. N Engl J Med. 2017; 376(7):617–28.
125. Bergenhenegouwen L.A., Meertens L.J.E., Schaaf J., Nijhuis J.G., Mol B.W., Kok M., et al. Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2014; 172:1–6.
126. No Title. Geneva; 2015.
127. Grabovac M., Karim J.N., Isayama T., Liyanage S.K., McDonald S.D. What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses. BJOG. 2018; 125(6):652–63.
128. Leek BF, McDonald D V.J. The spontaneous motility of human myometrial strips in vitro and its modification by some bacterial extracts. J Physiol. 1982; 324:42.
129. Smaill F. Intrapartum antibiotics for group B streptococcal colonisation. Cochrane database Syst Rev. 2000; (2):CD000115.
130. Benitz W.E., Gould J.B., Druzin M.L. Antimicrobial prevention of early-onset group B streptococcal sepsis: estimates of risk reduction based on a critical literature review. Pediatrics. 1999; 103(6):e78.
131. Ohlsson A., Shah V.S. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane database Syst Rev. 2013; (1):CD007467.
132. Asbill K.K., Higgins R. V, Bahrani-Mostafavi Z., Vachris J.C., Kotrotsios S.H., Elliot M.C., et al. Detection of Neisseria gonorrhoeae and Chlamydia trachomatis colonization of the gravid cervix. Am J Obstet Gynecol. 2000; 183(2):340–6.
133. Silver B.J., Guy R.J., Kaldor J.M., Jamil M.S., Rumbold A.R. Trichomonas vaginalis as a cause of perinatal morbidity: a systematic review and meta-analysis. Sex Transm Dis. 2014; 41(6):369–76.
134. Heumann C.L., Quilter L.A.S., Eastment M.C., Heffron R., Hawes S.E. Adverse Birth Outcomes and Maternal Neisseria gonorrhoeae Infection: A Population-Based Cohort Study in Washington State. Sex Transm Dis. 2017; 44(5):266–71.
135. Smaill F.M., Vazquez J.C. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane database Syst Rev. 2019; 2019(11).
136. Kenyon S., Pike K., Jones D.R., Brocklehurst P., Marlow N., Salt A., et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. Lancet (London, England). 2008; 372(9646):1310–8.
137. Tchirikov M., Schlabritz-Loutsevitch N., Maher J., Buchmann J., Naberezhnev Y., Winarno A.S., et al. Mid-trimester preterm premature rupture of membranes (PPROM): Etiology, diagnosis, classification, international recommendations of treatment options and outcome. J Perinat Med. 2018; 46(5):465–88.
Appendix A1. Working Group Composition
1. Amiraslanov Elrad Yusifovich – Candidate of Medical Sciences, Head of the Obstetric Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
2. Artymuk Natalia Vladimirovna – Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology named after Professor G.A. Ushakova, Kemerovo State Medical University of the Russian Ministry of Health, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Siberian Federal District (Kemerovo). No conflict of interest.
3. Baranov Igor Ivanovich – Doctor of Medical Sciences, Professor, Head of the Department of Scientific and Educational Programs, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
4. Bashmakova Nadezhda Vasilievna – Doctor of Medical Sciences, Professor, Chief Researcher, Research Institute of Maternity and Infancy of the Russian Ministry of Health, Honored Doctor of the Russian Federation, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Ural Federal District (Yekaterinburg). No conflict of interest.
5. Bezhenar Vitaly Fedorovich – Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Reproductology, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Russian Ministry of Health, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Northwestern Federal District (Saint Petersburg). No conflict of interest.
6. Belokrinitskaya Tatiana Evgenyevna – Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Advanced Training and Professional Retraining of Physicians, Chita State Medical Academy of the Russian Ministry of Health, Honored Doctor of the Russian Federation, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Far Eastern Federal District (Chita). No conflict of interest.
7. Dolgushina Natalia Vitalievna – Doctor of Medical Sciences, Professor, Deputy Director – Head of the Department for Organization of Scientific Activities, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
8. Kan Natalia Enkynovna – Doctor of Medical Sciences, Professor, Deputy Director, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
9. Karapetyan Tamara Eduardovna – Doctor of Medical Sciences, Senior Researcher of the Obstetric Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
10. Lomova Natalia Anatolievna – Candidate of Medical Sciences, Researcher of the Obstetric Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health (Moscow). No conflict of interest.
11. Malyshkina Anna Ivanovna – Doctor of Medical Sciences, Professor, Director of the V.N. Gorodkov Ivanovo Research Institute of Maternity and Childhood, Head of the Department of Obstetrics and Gynecology, Medical Genetics of the Medical Faculty, Ivanovo State Medical Academy of the Russian Ministry of Health, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Central Federal District (Ivanovo). No conflict of interest
12. Olenev Anton Sergeevich – Candidate of Medical Sciences, Chief freelance specialist in obstetrics and gynecology of the Moscow Healthcare Department, Head of the Branch – "Perinatal Center" of City Clinical Hospital No. 24 of the Moscow Healthcare Department. No conflict of interest
13. Olina Anna Alexandrovna – Doctor of Medical Sciences, Professor, Deputy Director of the Department of Medical Care for Children, Maternity Services and Public Health of the Ministry of Health of the Russian Federation. No conflict of interest
14. Radzinsky Victor Evsevievich – Honored Worker of Science of the Russian Federation, Doctor of Medical Sciences, Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with a Course in Perinatology, Peoples' Friendship University of Russia of the Ministry of Education of Russia (Moscow). No conflict of interest.
15. Savelyeva Galina Mikhailovna – Academician of the RAS, Doctor of Medical Sciences, Professor, Hero of Labor of the Russian Federation, Honored Worker of Science of the RF, Honorary Professor of the Department of Obstetrics and Gynecology of the Pediatric Faculty, Pirogov Russian National Research Medical University (Moscow). No conflict of interest.
16. Fatkullin Ildar Faridovich – Doctor of Medical Sciences, Professor, Honored Worker of Science of the Republic of Tatarstan, Honored Doctor of the Republic of Tatarstan, Head of the Department of Obstetrics and Gynecology named after Prof. V.S. Gruздеv, Kazan State Medical University of the Russian Ministry of Health, Chief freelance specialist in obstetrics and gynecology of the Russian Ministry of Health in the Volga Federal District (Kazan). No conflict of interest.
17. Sheshko Elena Leonidovna – Director of the Department of Medical Care for Children, Maternity Services and Public Health of the Ministry of Health of the Russian Federation (Moscow). No conflict of interest.
18. Shmakov Roman Georgievich – Doctor of Medical Sciences, Professor of the RAS, Director of the Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Acad. V.I. Kulakov of the Russian Ministry of Health, Chief freelance specialist in obstetrics of the Ministry of Health of the Russian Federation (Moscow). No conflict of interest.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience for these clinical guidelines:
1. obstetrician-gynecologists;
2. students, residents, postgraduate students in obstetrics and gynecology;
3. faculty members, researchers.
Table 1. Levels of Evidence (LoE) grading scale for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference-standard control or systematic review of randomized controlled trials (RCTs) with meta-analysis |
2 | Individual studies with reference standard control or individual RCTs and systematic reviews of studies of any design, except RCTs, using meta-analysis |
3 | Studies without sequential reference-standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Scale for grading levels of evidence certainty (LEC) for prevention, treatment, and rehabilitation methods (preventive, therapeutic, and rehabilitative interventions)
LoE | Definition |
|---|---|
1 | Systematic review of RCTs incorporating meta-analysis |
2 | Individual RCTs and systematic reviews of studies of any design except RCTs incorporating meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Scale for grading grades of recommendation (GR) for prevention, diagnostic, treatment, and rehabilitation methods (preventive, diagnostic, therapeutic, and rehabilitative interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Appendix A3. Reference Materials
Not applicable.
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
What is chorioamnionitis?
Chorioamnionitis is an infection resulting in inflammation of the fetal membranes, amniotic fluid, placenta, decidua, and the fetus.
What are the causes of chorioamnionitis?
Chorioamnionitis develops due to the penetration of microbes via an ascending pathway (from the vagina) or hematogenous pathway (from chronic foci of infection).
What are the clinical manifestations of chorioamnionitis?
Chorioamnionitis manifests as fever, uterine tenderness, and purulent or blood-tinged vaginal discharge.
What are the complications of chorioamnionitis?
Chorioamnionitis may lead to obstetric complications such as labor dystocia, postpartum hypotonic hemorrhage, endometritis, peritonitis, and septic complications in the mother and newborn.
How is chorioamnionitis treated?
The mainstays of treatment are antibiotic therapy and delivery.
What should be done if signs of chorioamnionitis are detected?
Contact your doctor immediately if you develop any of the following signs: fever above 38°C, tachycardia, changes in vaginal discharge, or altered fetal activity.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
Not applicable.