Document Detail


Progress in pathogenesis and management of clinical intraamniotic infection.
MedLine Citation:
PMID:  2035575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the past decade, gratifying progress has been achieved in our understanding of clinical intraamniotic infection. With a usual incidence of 1% to 4%, clinical intraamniotic infection mainly develops as an ascending process after prolonged rupture of the membranes and labor, but other cases may be hematogenous in origin whereas still others complicate intrauterine procedures. The most common organisms isolated in amniotic fluid of cases of intraamniotic infections are anaerobes, genital mycoplasmas, group B streptococci, and Escherichia coli. The latter two are found most commonly in maternal or neonatal bacteremia complicating intraamniotic infection. Although the diagnosis remains largely a clinical one, laboratory tests have been suggested to confirm the diagnosis in women with symptoms. These include amniotic fluid Gram stain, gas-liquid chromatography, and leukocyte esterase measurement. Maternal treatment consists of antibiotic therapy and delivery. Studies to date have used a penicillin plus an aminoglycoside, with some authors advocating the addition of clindamycin after cesarean delivery. Other broad-spectrum regimens may be equally effective. Complications of clinical intraamniotic infections include an increase in cesarean section rate and in maternal and neonatal bacteremia. Poor neonatal outcomes in intraamniotic infection are more likely in the following cases: (1) when E. coli or group B streptococci are present in the amniotic fluid; (2) when the infant has a low birth weight; (3) when maternal antibiotic therapy is delayed until after delivery.
Authors:
R S Gibbs; P Duff
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  164     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1991 May 
Date Detail:
Created Date:  1991-06-21     Completed Date:  1991-06-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1317-26     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver 80262.
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MeSH Terms
Descriptor/Qualifier:
Amniotic Fluid / microbiology
Ampicillin / therapeutic use
Bacterial Infections / diagnosis,  etiology*,  therapy
Birth Weight
Chorioamnionitis / diagnosis,  drug therapy,  etiology*
Chromatography, Gas
Clindamycin / therapeutic use
Drug Combinations
Esterases / biosynthesis
Extraembryonic Membranes / microbiology
Female
Gentamicins / therapeutic use
Humans
Leukocytes / enzymology
Leukocytosis / diagnosis
Obstetric Labor Complications / etiology
Pregnancy
Pregnancy Complications, Infectious*
Risk
Chemical
Reg. No./Substance:
0/Drug Combinations; 0/Gentamicins; 18323-44-9/Clindamycin; 69-53-4/Ampicillin; EC 3.1.-/Esterases

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