MISSION

“MABINI COLLEGES provides quality

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programs at all educational levels as its
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“MABINI COLLEGES shall growth and development.
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EXCELLENCE in Education.” students into:
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Name: Nick Martin Requejo Date: March 15,

2023
Block: BSN 2-A

Nursing Findings

Definition
Intraamniotic infection is infection of the chorion, amnion, amniotic fluid, placenta, or
a combination. Infection increases risk of obstetric complications and problems in the fetus
and neonate. Symptoms include fever, uterine tenderness, foul-smelling amniotic fluid,
purulent cervical discharge, and maternal or fetal tachycardia. Diagnosis is by specific
clinical criteria or, for subclinical infection, analysis of amniotic fluid. Treatment includes
broad-spectrum antibiotics, antipyretics, and delivery.

Risk Factors
Risk Factors for Intraamniotic infection include the following:
 Prolonged rupture of membranes (a delay of ≥ 18 to 24 hours between rupture and delivery)
 Premature rupture of membranes (PROM)
 Preterm labor
 Meconium-stained amniotic fluid
 Presence of genital tract pathogens (e.g., group B streptococci)
 Multiple digital examinations during labor in women with ruptured membranes
 Long labor
 Internal fetal or uterine monitoring

Complications
Intraamniotic infection can cause as well as result from preterm PROM or preterm
delivery. This infection accounts for 50% of deliveries before 30 weeks gestation. It occurs
in 33% of women who have preterm labor with intact membranes, 40% who have PROM
and are having contractions when admitted, and 75% who go into labor after admission for
PROM.

Fetal or neonatal complications include increased risk of the following:

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 Preterm Delivery
 Apgar Score
 Neonatal Infection (e.g., sepsis, pneumonia, meningitis)
 Seizures
 Cerebral Palsy
 Death

Maternal complications include increased risk of the following:

 Bacteremia
 Need for cesarean delivery
 Uterine Atony
 Postpartum Hemorrhage
 Pelvic Abscess
 Thromboembolism
 Wound Complication
 Placental Abruption

Symptoms and Signs of Intraamniotic Infection

Intraamniotic infection typically causes fever. Other findings include maternal
tachycardia, fetal tachycardia, uterine tenderness, foul-smelling amniotic fluid, and/or
purulent cervical discharge. However, infection may not cause typical symptoms (IE,
subclinical infection).

Intraamniotic infection is suspected and diagnosed based on clinical and sometimes

laboratory criteria. Findings are categorized as follows:
 Isolated maternal fever: A single oral temperature of ≥ 39° C or an oral temperature
of ≥ 38 to 39° C that is still present when the temperature is measured after 30
minutes (isolated maternal fever does not automatically lead to a diagnosis of
infection)
 Suspected intraamniotic infection based on maternal fever and clinical criteria
(elevated maternal white blood cell [WBC] count, fetal tachycardia, or purulent
cervical discharge)

Confirmed intraamniotic infection: Sometimes suspected intraamniotic infection is

confirmed by results of amniotic fluid tests (Gram staining, culture, glucose level—see
below) or histologic evidence of placental infection or inflammation
 MISSION
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Presence of a single symptom or sign, which may have other causes, is less reliable. For
example, fetal tachycardia may be due to maternal use of drugs or fetal arrhythmia.
However, if intraamniotic infection is absent, heart rate returns to baseline as these
conditions resolve.

Intraamniotic infection is usually confirmed after delivery through correlation with

placental pathology.

Subclinical infection
Refractory preterm labor (persisting despite tocolysis) may suggest subclinical
infection. If membranes rupture prematurely before term, clinicians should also consider
subclinical infection so that they can determine whether induction of labor is indicated.

Amniocentesis with culture of amniotic fluid can help diagnose subclinical infection.
The following fluid findings suggest infection:

 Presence of any bacteria or leukocytes using Gram staining

 Positive culture
 Glucose level < 15 mg/dL
 WBC count > 30 cells/mcL
Treatment of Intraamniotic Infection
 Broad-spectrum antibiotics
 Antipyretics
 Delivery

Treatment of intraamniotic infection is

recommended when:
 Intraamniotic infection is suspected or confirmed.
 Women in labor have an isolated temperature of ≥ 39° C and no other clinical risk
factors for fever.
 If women have a temperature of 38 to 39° C and no risk factors for fever, treatment
can be considered.

 Appropriate antibiotic treatment reduces morbidity in the mother and neonate.

 As soon as intraamniotic infection is diagnosed, it is treated with broad-spectrum IV

antibiotics plus delivery.
 MISSION
“MABINI COLLEGES provides quality
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EXCELLENCE in Education.” students into:
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 A typical intrapartum antibiotic regimen consists of both of the following:

 Ampicillin 2 g IV every 6 hours

 Gentamicin 2 mg/kg IV (loading dose) followed by 1.5 mg/kg IV every 8 hours or
gentamicin 5 mg/kg IV every 24 hours

In addition, if delivery is cesarean, one additional dose of the chosen

regimen plus a dose of clindamycin 900 mg IV or metronidazole 500 mg IV
can be given after the umbilical cord is clamped.

Women with a mild penicillin allergy can be given

 Cefazolin plus gentamicin

Women with a severe penicillin allergy can be given one of the following:

 Clindamycin (or metronidazole) plus gentamicin

 Vancomycin plus gentamicin
Vancomycin should be used in women who are colonized with group B streptococci
(GBS) if GBS is resistant to clindamycin or erythromycin unless clindamycin-inducible
resistance testing is negative and antibiotic is not available.

How long antibiotics are given varies, depending on individual circumstances (eg, how high
the fever was, when the fever last spiked in relation to delivery).

Antibiotics should not automatically be continued after delivery; use should be based on
clinical findings (e.g., bacteremia, prolonged fever) and on risk factors for postpartum
endometritis, regardless of the delivery route. Women who have a vaginal delivery are less
likely to develop endometritis and may not require postpartum antibiotics. After cesarean
delivery, at least one additional dose of antibiotics is recommended.

Antipyretics, preferably acetaminophen before delivery, should be given in addition to

antibiotics.

Intraamniotic infection alone is rarely an indication for cesarean delivery. Informing the
neonatal care team when intraamniotic infection is suspected or confirmed and what risk
factors are present is essential to optimize evaluation and treatment of the neonate.
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate aCULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: [email protected]  Locally and Globally
competitive persons

Prevention of Intraamniotic Infection

Risk of intraamniotic infection is decreased by avoiding or minimizing digital pelvic
examinations in women with preterm PROM.

Broad-spectrum antibiotics are given to women with preterm PROM to prolong latency until
delivery and decrease risk of infant morbidity and mortality.

Key Points
 Intraamniotic infection is infection of the chorion, amnion, amniotic fluid, placenta, or
a combination that increases risk of obstetric complications and problems in the fetus
and neonate.
 Consider the diagnosis when women have the classic symptoms of infection (eg,
fever, purulent cervical discharge, uterine pain or tenderness) or when fetal or
maternal tachycardia or refractory preterm labor is present.
 Determine the white blood cell count, and consider analyzing and culturing amniotic
fluid if women have refractory preterm labor or preterm PROM.
 Treat suspected or confirmed intraamniotic infection with broad-spectrum antibiotics,
antipyretics, and delivery.
 Also treat women in labor if they have an isolated temperature of ≥ 39° C and no
other clinical risk factors for fever.
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate aCULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 
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Drugs Mentioned
 Ampicillin - is used to treat certain infections that are caused by bacteria
such as meningitis (infection of the membranes that surround the brain
and spinal cord); and infections of the throat, sinuses, lungs, reproductive
organs, urinary tract, and gastrointestinal tract.
 Gentamicin - is used to treat serious bacterial infections in many
different parts of the body.
 Clindamycin - is used to treat certain types of bacterial infections,
including infections of the lungs, skin, blood, female reproductive organs,
and internal organs.
 Metronidazole – is used to treat skin infections, rosacea and mouth
infections, including infected gums and dental abscesses
 Cefazolin - is used to treat bacterial infections in many different parts of
the body
 Vancomycin - is used to treat infections caused by bacteria
 Erythromycin - is used to prevent and treat infections in many different
parts of the body, including respiratory tract infections, skin infections,
diphtheria, intestinal amebiasis, acute pelvic inflammatory disease,
Legionnaire's disease, pertussis, and syphilis.
 Acetaminophen - Acetaminophen is used to relieve mild to moderate
pain from headaches, muscle aches, menstrual periods, colds and sore
throats, toothaches, backaches, and reactions to vaccinations (shots), and
to reduce fever
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate aCULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 
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Reference:
Intraamniotic Infection – Retrieved online last 14th of March 2022 at 11:20 PM from:
https://www.merckmanuals.com/professional/gynecology-and-
obstetrics/abnormalities