When Water Breaks Before Delivery
Chorioamnionitis, a term often unfamiliar to many, is a serious infection that can occur when a woman’s water breaks before the onset of labor. This condition, affecting the membranes surrounding the fetus and the amniotic fluid, requires prompt medical attention to prevent potential complications for both the mother and the baby.
What is Chorioamnionitis?
Chorioamnionitis, often referred to simply as “chorio,” is an infection of the chorion and amnion, the membranes that surround the fetus and the amniotic fluid. It typically occurs when bacteria from the mother’s vaginal or rectal flora enter the amniotic cavity after the membranes have ruptured, commonly known as when the water breaks. This bacterial invasion triggers an inflammatory response, leading to maternal fever and potential harm to the fetus.
Causes and Risk Factors
Several factors can increase the risk of chorioamnionitis, including:
- Prolonged rupture of membranes (PROM): When the amniotic sac breaks more than 18 hours before the onset of labor, the risk of infection significantly increases.
- Invasive procedures: Certain medical interventions during pregnancy, such as cervical cerclage or amniocentesis, can introduce bacteria into the amniotic cavity.
- Group B Streptococcus (GBS) colonization: Women who carry GBS, a type of bacteria commonly found in the vagina and rectum, are at higher risk of developing chorioamnionitis.
- Sexually transmitted infections (STIs): Infections such as chlamydia or gonorrhea can increase the likelihood of chorioamnionitis.
- Immunosuppression: Conditions that weaken the immune system, such as diabetes or HIV, can make women more susceptible to infections during pregnancy.
Symptoms and Diagnosis
Symptoms of chorioamnionitis can vary but commonly include:
- Maternal fever (temperature above 100.4°F or 38°C)
- Rapid maternal heart rate
- Uterine tenderness
- Foul-smelling or discolored amniotic fluid
- Maternal and fetal tachycardia (rapid heart rate in both mother and baby)
Diagnosis is typically based on clinical symptoms, maternal fever being the most significant indicator. Laboratory tests may also be performed to assess maternal blood counts and cultures, as well as amniotic fluid analysis if available.
Risks and Complications
Chorioamnionitis poses several risks and complications for both the mother and the baby, including:
- Maternal complications:
- Sepsis: Chorioamnionitis can lead to systemic maternal infection, potentially progressing to sepsis, a life-threatening condition.
- Endometritis: Infection of the lining of the uterus (endometrium) can occur, requiring antibiotic treatment.
- Postpartum hemorrhage: In severe cases, chorioamnionitis may increase the risk of excessive bleeding after delivery.
- Fetal complications:
- Preterm birth: Chorioamnionitis is associated with preterm labor and delivery, which can increase the risk of complications for the newborn.
- Neonatal sepsis: Infants born to mothers with chorioamnionitis are at higher risk of developing bacterial infections shortly after birth.
- Respiratory distress syndrome (RDS): Premature infants are more likely to experience RDS, a breathing disorder common in preterm babies.
Treatment and Prevention
Prompt treatment of chorioamnionitis is crucial to prevent maternal and fetal complications. Treatment typically involves:
- Antibiotics: Broad-spectrum antibiotics are administered intravenously to combat the infection and prevent its spread.
- Labor induction: If the pregnancy is near term, delivery may be induced to remove the source of infection.
- Supportive care: Maternal hydration, pain management, and monitoring of maternal and fetal well-being are essential during treatment.
Prevention strategies for chorioamnionitis include:
- Screening for GBS colonization during pregnancy and administering antibiotics during labor to women at risk.
- Avoiding unnecessary invasive procedures during pregnancy.
- Prompt management of prolonged rupture of membranes to reduce the risk of infection.
Chorioamnionitis is a serious infection that can occur when a woman’s water breaks before the onset of labor. Prompt recognition and treatment of this condition are essential to minimize maternal and fetal complications. By understanding the risk factors, symptoms, and preventive measures associated with chorioamnionitis, healthcare providers can work to ensure the best possible outcomes for both mother and baby.
