Management of chorioamnionitis.
Chorioamnionitis presents as a serious threat to both mother and fetus. We have evaluated the diagnostic criteria and method of management by means of a retrospective analysis. Ninety-nine per cent of mothers had two of three major risk factors: 1, rupture of membranes; 2, leukocytosis of greater than 15,000, and 3, temperature greater than 100.4 degrees F. All three risk factors were present in 82.7 per cent. The method of management included culturing the endocervix when premature rupture of the membranes was present, administering parenteral antibiotics once the diagnosis of chorioamnionitis was made and performing cesarean sections for obstetric indications only. This management protocol resulted in a perinatal survival rate of 94.9 per cent in infants weighing more than 1,000 grams compared with 98.3 per cent in the general population and no perinatal deaths in infants weighing more than 1,500 grams. There were no maternal deaths. Our data support the recommendations that endocervical cultures be obtained for all patients with premature rupture of membranes, mothers with ROM and normal temperature and white blood cell count be managed without antibiotics, mothers with a diagnosis of chorioamnionitis have induction of labor and cesarean section be performed for obstetric indications only.