Faculty of Midwifery at Babol University of Medical Sciences, Iran.

Abstract

Background and objectives:

Chorioamnionitis is a common event in labor. The purpose of this study was determined the frequency of clinical chorioamnionitis in women with vaginal delivery in imam hospital.

METHOD: Chorioamnionitis was defined as a maternal fever (>38°C) to be associated with at least two of following five criteria are also present: maternal tachycardia, foul-smelling amniotic fluid, fetal tachycardia, uterine tenderness or maternal leuckocytisis, RESULTS: clinical Chorioamnionitis occurred in 1 percent of all pregnancies. ( 2 cases of intact membrane and 2 cases of PROM). 9.3 percent of all births were preterm labor and Chorioamnionitis wasn’t occurred to this group. CONCLUSTION: These results also show that prevalence of Chorioamnionitis is rare in my country and it is suggested because of sexual transmitted disease is rare.

Introduction:

Chorioamnionitis is the general term for infection of amniotic membranes (the chorion, amnion placenta, and also sometimes the umbilical cord by bacteria, mycopalsma and ureaplasma during pregnancy. The infection weakens the membranes, which results in their premature rupture. Inflammation cause swelling around the placenta villa which reduces the flow of blood and causes hypoxia in the fetus and by-products of bacteria and/or of fetal distress initiate preterm labor (1). The bacteria can also make the baby ill. Pneumonia in newborn is nearly always caused by Chorioamnionitis. Exposed neonates are also at greater risk of septicemia and more rarely of neonatal otitis media, meningitis and septic arthritis (2) and it can also mak septicemia, postpartum hemorrhage and labor dystocia in mother (3). There is no universally accepted set of criteria for making the diagnosis at acute chorioamnionitis. However, from a practical standpoint, the diagnosis is based on clinical finding- that is leukocytosis, maternal fever, maternal tachycardia, a tender uterin and foul smelling amniotic fluid (4). Treatment consist of antibiotics should began as soon as the diagnosis is made unless delivery is imminent (less than 1hour). (4,5). The purpose of this study was determined the frequency of Chorioamnionitis in women with vaginal delivery in Imam hospital in sari.

Material and Methods

The study group included 400 patients who hospitalized in Imam hospital in sari that is included singleton pregnancies that all subjects delivered vaginally. Table 1 shows population characteristics. Chorioamnionitis was diagnosed

Table l. Population Characteristics

The diagnosis of clinical chorioamnionitis was made in the presence of two of the following criteria: maternal fever>38°c) maternal tachycardia (heart rate above 120 beats per minute), fetal tachycardia (heart rate above 160 beats per minute), uterine tenderness, foul–smelling anniotic fluid, or maternal leukocytosis (white blood cell count 15000 μl or more). Gestational ages were determined by last menstrual period. when that day was unknown, gestational duration was estimated from the Dubowitz score at birth. Preterm birth was defined as delivery before 37- week and PROM as rupture of the fetal membranes before the onset of labor. In this study of patients, rupture of the membranes was documented by sterile speculum examination, pooled amniotic was examined for ferning and nitrazine determination. Elapsed time of PROM was defined as the period between rupture of membranes and delivery. Antibiotics were usually given after 12 hours of PROM.

Results

Clinical chorioamnionitis occurred in 1 percent of all pregnancies.2 cases of intact membrane and 2 cases of PROM. These patients had an interval between rupture of membranes and deliver of 20-30 hrs.9.3 percent of all birth were preterm labor and chorioamnionitis was not occurred to this group. Table 2: shows clinical finding in all women.

Table 2. Clinical finding

* no determin

Discussion

This study showed that frequency of chorioamnionitis in women with PROM and intact membran is similar.

Newton (1993) reported that chorioamniontis occurred in 2-4% of all pregnancies (6).

Seo et al (1992) reported clinical chorioamniontis occurred more frequency among women delivering on term membrane) and also these outhorses’ reported that it occurred more frequency among women delivering before term with PROM. (26.5PROM versus5.8%)(7). Kitajim et al (1992) reported that histological chorioamniontis in the placenta occurred 30-50% of preterm deliveries (8) while in this study, clinical chorioamniontis Wasn’t occurred in preterm delivery and these results also showed that prevalence of chorioamniontis in rare in may countary and it is suggested because of sexual transmitted disease is rare.

Reference:

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7. Soeo K,et al.Preterm birth is associated with increased risk of maternal and neonatal infection,obstetrics,1992;79(1)75-80.

8. Kitajimah, et al. Significance of chorioamniontis early human develop, 1992; 29 (1-3): 125- 30.