gynecology and obstetrics
Intraamniotic Infection
Diagnosis of Intraamniotic Infection
Maternal fever during labor without other identifiable cause Amniocentesis for suspected subclinical infection Intraamniotic infection is suspected and diagnosed based on clinical and sometimes laboratory criteria. There are 3 diagnostic categories ( Diagnosis reference ): Isolated maternal fever:A single oral temperature of ≥ 39° C or an oral temperature of 38 to 38.9° C that is still present when the temperature is measured again after 30 minutes (isolated maternal fever does not automatically lead to a diagnosis of infection) Suspected intraamniotic infection:Maternal fever and one or more of the following: elevated maternal white blood cell [WBC] count, fetal tachycardia, or purulent cervical discharge Sometimes further evaluation is indicated to confirm intraamniotic infection by Subclinical infection (Gram staining, culture, glucose level) or histologic evidence of placental infection or inflammation Presence of a single symptom or sign, which may have other causes, is less reliable. For example, fetal tachycardia may be due to fetal distress for other reasons, eg, medications,cocaine, or maternal hyperthyroidism. Refractory preterm labor (persisting despite tocolysis) may suggest subclinical infection. If membranes rupture prematurely before term, clinicians should consider subclinical infection to 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 bacteria or leukocytes using Gram staining Glucose level<14 mg/dL WBC count>30 cells/mcL Trace or greater leukocyte esterase activity (tested with urine dipstick reagent strip) Positive culture Other diagnostic tests for subclinical infection are under study. 1.American College of Obstetricians and Gynecologists: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection.Obstet Gynecol.2017 (reaffirmed 2022); 130(2):e95-e101. doi:10.1097/AOG.0000000000002236 