Chorioamnionitis: cause or effect?

In four cases of one twin pregnancy and three triplet pregnancies, efforts were made to prolong the pregnancy after the death of one foetus between 15th and 26th weeks of gestation. Two patients had a history of spontaneous abortion, three patients had undergone infertility treatment. In a further three cases the membranes ruptured prematurely in association with severe disturbance of the vaginal flora. Treatment consisted of rest in bed, sedation, and administration of magnesium and antibiotics. Neither cervical cerclage nor general IV tocolysis were performed. Although the pregnancies could be prolonged for 4, 22, 28, and 76 days, they all terminated before the 27th week, mainly due to ascending infection. Of the 11 children, two survived with no morbidity, two children (B and C of the third triplet pregnancy), died 2 and 19 days after delivery, respectively, and seven were stillborn. A comparison with prolongations of twelve twin and four triplet pregnancies reported in the literature, reveals the various concepts for treatment. After infection has been ruled out and the parents have been fully informed, efforts could be made to prolong the multiple pregnancy after the death of one foetus until the surviving child is viable. This requires intensive supervision.

Chorioamnionitis↗

PubMed1992

Pregnancy outcome following preterm premature rupture of the membranes at less than 26 weeks' gestation.

The outcome of 71 singleton pregnancies where premature rupture of the membranes (PROM) occurred at gestations of less than 26 weeks was assessed retrospectively. The incidence of chorioamnionitis was 39.4% and the overall maternal morbidity rate was 53% but there were no long-term maternal sequelae. The latent period from PROM until delivery ranged from less than 12 hours to 77 days, with 41% of women delivering within 1 week. There was no increased risk of infection with increasing latent period. The perinatal mortality was 66.2% (26.7% stillbirths and 39.4% neonatal deaths). There was a 65% chance of a live baby if PROM occurred between 24-26 weeks but only 5 of 40 fetuses (12.5%) survived if PROM occurred before 24 weeks. The use of antibiotics, tocolytics and steroids in an uncontrolled manner is reported. Overall there is little serious risk to the mother if a conservative approach is adopted but only about one-third of such women will take home a live baby.

Chorioamnionitis↗