Intrauterine infection

Evidence  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242863/ 

Varkha Agrawala and Emmet Hirscha, 

At least 40% of preterm births are associated with intrauterine infection. In individual cases it is often difficult to determine whether infection is the cause or consequence of the processes leading to preterm delivery. However, there is abundant evidence that infection and the inflammation generated by infection, whether within the gestational tissues or elsewhere, are a primary cause of a substantial proportion of preterm births. 

Education 

Intrauterine infection, also known as chorioamnionitis, is when the placenta, amniotic fluid or the membranes that surround your baby in the womb are infected. 

Chorioamnionitis affects around 1% to 4% of full-term deliveries (if your baby is born after 37 weeks of pregnancy). It is much more common in premature births (if your baby is born before 37 weeks of pregnancy) where it affects 40% - 70% of births. 

What are the symptoms of an intrauterine infection?  

Sometimes there aren’t any symptoms and healthcare professionals may only suspect chorioamnionitis if your waters break early (preterm prelabour rupture of membranes or PPROM).   

If you do have symptoms of chorioamnionitis, they can include: 

• Fever  

• Pain in your abdomen and tenderness over the womb (in your pelvic area) 

• Vaginal discharge with an unpleasant smell or a green or yellow colour 

• You and/or your baby having a fast heart rate. 

An intrauterine infection may start with mild, vague symptoms, but it can get worse quickly and make you and your baby very sick. 

Vaginal discharge 

It’s normal to have more discharge in pregnancy. But call your doctor or midwife if you have vaginal discharge and: 

• it smells unpleasant or strange 

• it is green or yellow 

• you feel itchy or sore around your vagina 

• you have pain when you wee. 

Urinary tract infections 

Urinary tract infections (UTIs) can lead to chorioamnionitis if they are not treated. Find out more about the symptoms of a urinary tract infection.  

Women do not always have symptoms of UTIs. This is one of the reasons why you’ll be asked to give a urine sample during your routine antenatal appointments. 

What can happen if I get an intrauterine infection? 

An intrauterine infection can lead to you and your baby having complications. 

It increases your risk of: 

• postpartum haemorrhage 

• other infections such as endometritis or a blood infection (sepsis) 

• needing to have a caesarean birth 

• blood clots 

• placental abruption 

• sepsis 

It increases your baby’s risk of: 

• being born preterm 

• having a very low Apgar score 

• infections such as pneumonia or meningitis and sepsis 

• cerebral palsy 

• seizures 

What causes an intrauterine infection? 

Intrauterine infections are usually caused by bacteria from your vagina that move up into the uterus. This is most likely to occur after your waters break. When the protective sac around your baby tears, it allows bacteria to get in from outside. 

Bacteria can get into your uterus during a procedure such as amniocentesis. Bacteria can also spread from your blood to your uterus through the placenta, but this is rare. 

There may be several types of bacteria involved. Bacteria that can cause an intrauterine infection include: 

• Group B streptococcus. 

• Escherichia coli 

• Listeria 

• Gonorrhoea

What increases the risk of an intrauterine infection? 

There are some factors that increase the risk of infection. This includes if you: 

• Smoke during pregnancy. 

• Drink alcohol or take illegal drugs during pregnancy. 

• Have a sexually transmitted infection, such as trichomoniasis, chlamydia, gonorrhoea, syphilis or HIV  

• Group B strep (GBS) colonisation 

• Bacterial vaginosis (BV).  

How is an intrauterine infection diagnosed? 

Your doctor may diagnose an intrauterine infection based on your symptoms. You might have blood tests and a vaginal swab to detect what type of bacteria is causing your infection. 

How is an intrauterine infection treated? 

An intrauterine infection is treated urgently with antibiotics. You will receive 2 or 3 different types of antibiotics through a needle into your vein. 

You may need to be admitted to hospital. You may also receive: 

• fluids into your vein 

• medicine to prevent blood clots 

• paracetamol to lower your fever 

The doctor might recommend baby be birthed early, due to the risk factor of chorioamnionitis.  

Your obstetric team will discuss your options and whether they recommend an induction of labour or an emergency caesarean. The safest option for you depends on your circumstances. 

If you are less than 35 weeks pregnant, you may be given an injection of steroid medicine to help your baby’s lungs develop. 

Empowerment  

It’s not always possible to predict if babies will have health problems from an intrauterine infection. However, if you are treated promptly with antibiotics, this will lower your baby’s risk.  

Your baby may develop an infection. The hospital staff will watch your baby’s health closely. If the risk is high, your baby might be given preventive antibiotics even if they are well. 

Useful Links  

King Edward Memorial Hospital for Women - KEMH 

https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Infection-Postnatal-Infection-Treatment.pdf?thn=0 

What to expect  

https://www.whattoexpect.com/pregnancy/pregnancy-health/complications/chorioamnionitis.aspx 

Belly Belly Australia 

https://www.bellybelly.com.au/pregnancy/chorioamnionitis-what-you-need-to-know-and-do/