ACOG Released Guidelines On Intraamniotic Infection

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Recommendations for the management of intrapartum intraamniotic infection are provided in new guidelines. The committee opinion was published by The American College of Obstetricians and Gynecologists (ACOG) online on July 25 and in the August issue of Obstetrics & Gynecology.

The authors wrote that “Recognition of intrapartum intraamniotic infection and implementation of the treatment recommendations are essential steps that can effectively minimize morbidity and mortality for women and newborns.”

Intraamniotic infection results in inflammation of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. It is also known as chorioamnionitis, that often involves multiple pathogenic organisms, typically results from ascending migration of cervical or vaginal flora, and commonly occurs among preterm and term parturient women. Though, most cases diagnosed and managed by obstetrician/gynecologists involve term patients in labor.

Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death. It can also result in long-term complications for the child, such as bronchopulmonary dysplasia and cerebral palsy.

Intraamniotic infection can lead to complications for the mother as well, such as postpartum hemorrhage, endometritis, and sepsis.

Clinicians should suspect intraamniotic infection when the mother’s temperature is 39.0°C or higher or when it is between 38.0°C and 38.9°C in the presence of another clinical risk factor such as maternal leukocytosis, purulent cervical drainage, or fetal tachycardia, opined the committee.

Use of intrapartum antibiotics and antipyretics is recommended by ACOG when intraamniotic infection is suspected or confirmed. Clinicians should ensure labor progresses normally in affected women as the intraamniotic infection is associated with dysfunctional labor. However, ACOG emphasizes that intraamniotic infection alone is not an indication for immediate delivery and is rarely, if ever, a reason for cesarean delivery.

Ampicillin and gentamicin, cefazolin and gentamicin, or clindamycin or vancomycin and gentamicin are recommended antibiotic regimens for treatment of intraamniotic infection. Antibiotic therapy should only be continued post-delivery in women with risk factors for postpartum endometritis, such as bacteremia or persistent fever; women undergoing cesarean deliveries are also more likely to have endometritis than those undergoing vaginal delivery.

Unless a secondary cause is apparent, clinicians should also consider antibiotic therapy in cases of isolated maternal fever.

The critical need for clinician communication between the maternal and neonatal healthcare teams is also highlighted by the opinion.

The opinion concludes that “Timely maternal management together with notification of the neonatal health care providers would facilitate appropriate evaluation and empiric antibiotic treatment when indicated.”

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