Clinical chorioamnionitis: where do we stand now?

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Neonatal Care

Background:

• Intraamniotic infection, now termed chorioamnionitis, involves inflammation of fetal membranes and surrounding structures.
• It can occur before, during, or after labor, presenting acutely, subacutely, or chronically.
• Current treatment lacks robust evidence due to limited randomized controlled trials.

Purpose of the Study:

• To review the current understanding and treatment approaches for chorioamnionitis.
• To highlight the evidence gaps in optimal antibiotic regimens for intraamniotic infections.
• To emphasize the necessity of delivery alongside antibiotic therapy.

Main Methods:

• Literature review of existing studies on chorioamnionitis treatment.
• Analysis of current clinical practices and guidelines for managing intraamniotic infections.
• Evaluation of antibiotic regimens, including first-line recommendations.

Main Results:

• Treatment for chorioamnionitis varies globally due to diverse bacterial causes and insufficient evidence.
• Amoxicillin or ampicillin combined with once-daily gentamicin is a common first-line regimen.
• Delivery is essential for cure; antibiotic therapy alone is insufficient.

Conclusions:

• Evidence-based antibiotic selection for chorioamnionitis is limited.
• Treatment decisions are influenced by local protocols, resistance patterns, and individual patient factors.
• Amoxicillin/ampicillin and gentamicin are recommended for patients ≥34 weeks gestation or in labor, pending further research.