gynecology and obstetrics
Intraamniotic Infection
Treatment of Intraamniotic Infection
Broad-spectrum antibiotics covering gram positives, gram negatives, and anaerobes Antipyretics Delivery as indicated 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 and delivery (see table). A typical intrapartum antibiotic regimen (for a patient with no allergy to penicillin) consists of both of the following: Ampicillin2 g IV every 6 hours AND Gentamicin2 mg/kg IV (loading dose) followed by 1.5 mg/kg IV every 8 hours ORgentamicin5 mg/kg IV every 24 hours Antibiotics should not automatically be continued after delivery; use should be based on clinical findings (eg, bacteremia, prolonged fever) and on risk factors for postpartum endometritis, regardless of the delivery route. The risk of postpartum endometritis and pelvic infection is higher after cesarean versus vaginal delivery. After cesarean delivery, patients with intraamniotic infection should receive one additional dose of the intrapartum antibiotic regimen plus anaerobic coverage; a dose ofclindamycin900 mg IV ORmetronidazole500 mg IV is given after the umbilical cord is clamped. before delivery, should be given in addition to antibiotics. Antipyretics to manage fevers may improve fetal status during labor, based on fetal monitoring ( Treatment reference ). Intraamniotic infection alone is rarely an indication for cesarean delivery. Informing the neonatal care team when intraamniotic infection is suspected or confirmed and which risk factors are present is essential to optimize evaluation and treatment of the neonate. 1.Lieberman E, Lang J, Richardson DK, et al: Intrapartum maternal fever and neonatal outcome.Pediatrics105(1 Pt 1):8-13, 2000. doi:10.1542/peds.105.1.8 