Pregnancy is an exciting time where, amongst decorating the nursery and wondering how many baby bottles you need, you also get to feel your baby growing inside you.
During pregnancy, it is completely normal to pay closer attention to your body including all its aches and pains or any changes to its usual function. After all, your body is housing your baby during the nine months of pregnancy and keeping them safe so it's understandable that you'll want to keep in tune with it all.
Moms-to-be expect stretch marks as their body expands to accommodate their growing body so seeing these appear won't be cause for alarm but pain, particularly in the abdominal area can leave you concerned and anxious. One such cause of pain is intrauterine infection, also known as clinical chorioamnionitis. As infections go, it is quite a common one that is usually dealt with quickly and does not affect the birth of your child, however, it can have serious consequences if not treated properly.
If you want to find out more about this maternal condition, how it presents itself, and the implications it has for your pregnancy and birth, then read on for more information. Of course, if you are experiencing any symptoms or you are feeling unwell at any point during your pregnancy, then be sure to contact your healthcare provider. Even if it is discovered there is nothing wrong, you'll get that all-important peace of mind that you and your baby are healthy.
What Is An Intrauterine Infection?
Maternal intrauterine infection, also commonly referred to as an intraamniotic infection or chorioamnionitis, is an infection in the womb which causes inflammation of the fetal membranes.
Chorioamnionitis And The Anatomy
There are two fetal membranes that intrauterine infection may affect: the chorion and amnion. The chorion is the outermost membrane of those that make the amniotic sac. It supports the much thinner inner membrane and is the membrane that is physically closest to the mother.
The amnion is the inner membrane and the one that is in direct contact with the amniotic fluid in which the fetus develops. As a result of intraamniotic infection, the membranes swell and the amniotic fluid can also become infected, all of which can be a risk to your baby and to the health of women long term. In addition, the infection may also affect the umbilical cord, this is referred to as funisitis.
Intrauterine Infection Causes
Chorioamnionitis occurs when bacteria that is normally harmless and present within the vagina or on the human skin move to parts of the reproductive system where it shouldn't be. The most common cause of intrauterine infection is bacteria moving from the vagina, into the genital tract, and onto the uterus where it then affects the membranes and amniotic fluid.
That being said, chorioamnionitis can also happen as a result of bacteria reaching the womb via the placenta or fallopian tubes, or via medical procedures such as amniocentesis, where a sample of amniotic fluid is taken to diagnose chromosomal abnormalities or fetal infections.
Bacteria that can travel up the genital tract and cause chorioamnionitis include bacterial vaginosis, chlamydia, E-coli, gonorrhea, HIV, syphilis, and trichomona.
The Difference Between A Uterine Infection And A UTI
UTIs (or urinary tract infections) are a common infection occurring more frequently in women than men and are usually caused by the bacteria Escherichia coli making its way into the urinary tract and bladder. Lower urinary tract infections affect the bladder and urethra. Symptoms of a lower UTI include pain when urinating, the feeling of needing to urinate even with an empty bladder and or urinating frequently as well as a fever, nausea and vomiting, pain in your sides or lower back, and blood in the urine.
Lower UTIs occur in about 10% of pregnancies and risk factors for infection may include sexual intercourse, obesity, diabetes, and family history. They do not pose a risk to a developing fetus and are usually treated at home with remedies such as cranberry juice, or with a short course of antibiotics.
Upper tract UTIs are different as they affect the kidneys. These can be life-threatening as there is the risk that bacteria can move from the kidneys and enter the bloodstream. This condition is called urosepsis, and it can result in dangerously low blood pressure, shock, and even death.
Symptoms of an upper urinary tract infection include many of the same symptoms of a lower urinary tract infection so it is best to contact your healthcare provider if you experience any of those mentioned.
What Are The Symptoms To Look Out For?
Chorioamnionitis is a serious condition in pregnant women that can affect the birth of their unborn child and result in preterm delivery. Therefore it is important to know the symptoms of the condition so you can take the necessary steps if you think you may have an infection.
Intrauterine Infection Symptoms
Although chorioamnionitis infection may not always cause symptoms, some infected women may find the following symptoms occur:
Rapid heartbeat (this may also occur for the fetus too).
Low blood pressure.
A discharge from the vagina that has an incredibly unpleasant smell.
High white blood cell count.
Whilst chorioamnionitis occurs in women as a result of normal skin or vaginal bacteria entering passing the cervix and entering the uterus, there is a range of risk factors that can make a mother more susceptible to this happening. Some related risk factors for intra-amniotic infection are:
Preterm labor where contractions occur before 37 weeks gestation.
Meconium-stained amniotic fluid.
Internal fetal or uterine monitoring such as amniocentesis.
Multiple digital examinations during labor in women whose amniotic membranes have ruptured.
Premature rupture of membranes (PROM).
Prolonged rupture of membranes where the time between the rupture and delivery of the baby is more than 12 hours.
Young maternal age (under 21 years of age).
Effects Of An Intrauterine Infection During Pregnancy
A clinical intraamniotic infection can be dangerous for both the health of the mother and baby with the most severe effect of the disease being the death of the fetus. Chorioamnionitis is the cause of approximately 50% of deliveries that occur before 30 weeks gestation and that's why infections must be dealt with and given the required treatment swiftly.
As already discussed, clinical intrauterine infection occurs as a result of vaginal or other bacteria normally present on human skin entering the uterus via the vagina, placenta, fallopian tubes, or very rarely, the colon. It causes inflammation of the fetal membranes and can also cause placental infections.
This infection can have a serious effect on pregnancy, especially if it causes the premature rupture of the amniotic membranes that protect the fetus. It can also cause the release of the hormone prostaglandin and cervical ripening, which may result in early labor and preterm birth.
Intrauterine infections can increase the risk of complications for the mother preterm, during delivery, and after birth. Possible complications for the mother include:
Bacteria in the bloodstream.
Delivery of the baby via Cesarean section.
Abscesses or infections within the pelvis.
Infection in the lining of the uterus.
The placenta detaching from the uterus prematurely.
Complications For The Fetus
If chorioamnionitis is not treated effectively in infected women, it can cause perinatal problems for the fetus and also result in lasting conditions for infants. Complications for the fetus include preterm labor, seizures, neonatal infections including sepsis or meningitis, growth restrictions, respiratory conditions, brain injury, and death.
Long Term Conditions
In extreme instances where infections are not detected or the treatment of chorioamnionitis is not managed effectively, it can result in long-term conditions for infants including Hypoxic-Ischemic Encephalopathy (HIE) and cerebral palsy.
HIE is a form of brain damage that is caused when the baby receives an insufficient flow of oxygenated blood during or near to their birth. Whilst it is a broad term used to describe neonatal brain injuries, the lack of blood flow can also cause problems with other organs including the lung, liver, and heart.
When diagnosed, HIE is categorized as mild, moderate, or severe and can result in a long-term disability or unfortunately, death. If after birth, your doctor suspects HIE, they may use cerebral function monitoring to track brain activity or use an ultrasound or MRI to obtain an image of your baby's brain. Such imaging will be able to tell if there is any damage to the brain and also detect any swelling or bleeding.
Whilst some infants fully recover from HIE after birth, others have lasting damage to their brain which results in impairment of their motor, cognitive or sensory development. One such condition is cerebral palsy which affects movement and coordination. Infants may also develop problems with their eyesight and hearing or having learning difficulties. HIE can also result in epilepsy which is a disease of the brain that causes seizures.
What Is The Treatment Plan?
Diagnosis of a uterus infection can be hard to spot initially, especially if the mother has no symptoms but if you ever have any concerns regarding chorioamnionitis and your health, seek information and advice from your healthcare provider. If they share your concerns, they can take steps to diagnose and treat the infection.
How Is Chorioamnionitis Diagnosed?
Diagnosis of chorioamnionitis can be done in a number of ways with the first being the discussion of your symptoms and a physical examination. In addition, a blood test can be used to check for bacteria and an ultrasound can be conducted to check the health of the fetus. Whilst the amniotic fluid can be tested for the presence of infection, this process is invasive and can increase the chance of intraamniotic infection occurring if it hasn't already, so it is usually avoided where possible.
If diagnosed with chorioamnionitis infection, you may be prescribed a course of antibiotics as treatment in order to prevent maternal and fetal complications. If a diagnosis reveals that an infected woman is at higher risk of complications, or oral antibiotics are not working effectively, then they may be admitted to the hospital for closer perinatal monitoring and treatment and so that they can be given antibiotics intravenously. Antibiotics commonly used to treat chorioamnionitis include ampicillin, clindamycin, gentamicin, metronidazole, and penicillin.
Delivery Of The Baby
We already know that early labor and thus, premature delivery occurs in some cases as a result of an infection within the vaginal and reproductive system. If your waters break early or you begin to experience contractions, then it may be decided to induce a birth before 40 weeks. In some instances of intrauterine infection, the decision may be made by your healthcare team to induce a preterm delivery in order to prevent complications.
As with any disease or infections you might be worried about during pregnancy, you should always contact your doctor or another professional in the healthcare system straight away if you fear you are showing any signs of an intrauterine infection such as fever or pain. Whilst our article has highlighted what can happen in the most severe instances of chorioamnionitis, please bear in mind that its diagnosis is common and it usually can be dealt with quickly and effectively, without causing problems during birth. It is only if it goes unnoticed and untreated that severe complications can become a threat. For the majority of women who do contract chorioamnionitis, the outcomes are very good and there is no impact on future fertility or the ability to have a healthy birth.
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