FETAL INFECTION

Infection of the liquor surrounding the fetus (chorioamnionitis) is not only a common source potentially serious illhealth in the new mother (Medical Litigation News Volume 3, Issue 10) but also a major cause and result of preterm Premature Rupture of Membranes (PRoM), preterm birth (prematurity) and life-threatening illness in the newborn infant[1].

Except when maternal colonisation[1] with Group B -Streptococcus (GBS) is present or unknown, controversy[2], [3] continues over the utility of prophylactic antibiotics in the management of PRoM around an apparently healthy fetus.

Apparently healthy is a central clinical concern, and is an occasional focus of medical malpractice litigation. The clinical features[4] of chorioamnionitis are well-known, but clinical threshhold for suspicion may be too high according to recent research[5].

PRACTICE POINT

Look for:
1.    fever >37.7 degrees C
2.    rapid maternal or fetal heart-rate
3.    tenderness of the uterus
4.    raised White Blood Cell Count (WBC)
5.    purulent amniotic fluid

A combination of laboratory tests is highly discriminating in the identification of chorioamnionitis and should perhaps be requested more readily[6].

PRACTICE POINT

Did the obstetrician test?
1.    White Blood Cell Count (WBC)
2.    C-Reactive Protein (CRP)
3.    elastase alpha 1-proteinase inhibitor        complex (E alph 1 PI)

After an initial decision that the PRoM was uncomplicated, failure of continuing vigilance may result in potentially preventable tragedy.