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Home >> PracticeAreas >> Prenatal(BeforeBirth)andLabor&DeliveryBirthInjuries >> MaternalInfections >> ChorioamnionitisandVillitis

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ChorioamnionitisandVillitis(Infections)
CHORIOAMNIONITIS AND VILLITIS ATTORNEYS IN MICHIGAN, OHIO,
WASHINGTON DC, AND NATIONWIDE
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Chorioamnionitis,orintramnioticinfection,isaninflammationoftheplacenta/fetalmembranes
(calledthechorionandamnion)causedbybacteriaascendingintotheuterusfromthevagina.The
ascensionofbacteriaistypicallyassociatedwithprolongedlaborandmembranerupture(a
motherswaterbreaking),butchoriomnionitiscanalsooccurwithintactmembranes.
Chronicchorioamnionitisiscommonlyassociatedwithvillitis,whichisinflammationofthe
chorionicvillisurfaceoftheplacenta.Chorionicvillideveloptomaximizesurfaceareacontact
withmaternalbloodfornutrientandgasexchangewithfetalblood.Villitisisveryserious,and
whentheconditionispresent,thechanceoffetaldeathisincreased.

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Itiscrucialthatphysicianspromptlydiagnoseandtreatchorioamnionitisandtheinfectionsthat
canleadtovillitis.Ifadoctormishandlestreatment,theremaybedevastatingconsequencesfor
thebabyincluding:
Apr15th2015

ImproperUseofForcepsDuring
Duringbirthofasecondtwin,the
TwinDeliverycausesBrain
obstetrician
Apr14th2015

$7.8MillionforBoywithCerebral
Thiscasehighlightstheimportanceof
Palsy&BrachialPlexusInjuries
aCsection
Apr14th2015

MichiganMedicalMalpractice
Wehavewrittennumerousarticles
Lawyers&BirthInjuryAttorneys

Hypoxia(significantlyreducedoxygensupply)
Hydropsfetalis(abnormalamountsoffluidbuildupintwoormorebodyareasofafetusor
newborn)
Intrauterinegrowthrestriction(IUGR)
Prematureruptureofthemembranes(PROM)
Pretermbirth
Respiratoryproblems
Meningitis
Encephelopathy(braininjury,suchashypoxicischemicencephalopathy)
Braindamage,suchascerebralpalsyandperiventricularleukomalacia(PVL)
Neonatalsepsis(bloodinfection)
Fetaldeath/stillbirth

Apr8th2015

Ifyouwerediagnosedwithchorioamnionitisoraninfectionthatledtovillitisandyourchild
sustainedaseriousinjuryasaresult,pleasecalloneofthebirthinjuryattorneysatReiter&
WalshABCLawCenters.Wewillreviewyourmedicalrecordsanddetermineifnegligence
exists.Wellletyouknowwhatyourlegaloptionsare.Callourofficeat(888)419BABY.

CerebralPalsy&Intellectual
Achildhascerebralpalsyand
DisabilitiescausedbyDelayed

CAUSES OF CHORIOAMNIONITIS AND VILLITIS

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Chorioamnionitis
Inchorioamnionitis,infectious
organismsarepassedfromthecolon,
cervixandvaginatotheuterus,where
thebabyislocated.Specifically,the
chorioamnionand/orumbilicalcord
oftheplacentabecomeinfectedand
inflamed.Lesscommonroutesof
infectionincludepassageof
infectiousorganismsduring
amniocentesisorchorionicvillous
sampling.Onceinfectedwith
bacteria,thereisamaternalandfetal
inflammatoryresponsethatmaylead
toreleaseofthehormone
prostaglandin,ripeningofthecervix,

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membraneinjury,andlaborattermorprematurely.
Villitis
Villitisisassociatedwithplacentalinfections.Thereareseveralconditionsthatcancausevillitis,
butinmanycasesthecauseisunknown.
Bacterialcausesofvillitisincludethefollowing:
Chorioamnionitis
Streptococci
Bacteriaassociatedwithmaternalsepsis

Viralcausesofvillitisinclude:

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Cytomegalovirus(CMV)
Toxoplasmosis
Herpes
Rubella
Syphilis

RISK FACTORS FOR CHORIOAMNIONITIS AND VILLITIS

Chorioamnionitis

Prematurelabor
Fetalmembranesthatareruptured(thewaterhasbroken)foraprolongedperiod
Prolongedlabor
Nulliparity(nopriorbirths)
GroupBstreptococcus(GBS)
Bacterialinfections,suchasurinarytractinfection(UTI),bacterialvaginosis(BV)and
ureaplasma
Obesityduringpregnancy
Shortcervix(incompetentcervix)
Useofthehormonevaginalprostaglandinduringlabor
Internalmonitoringoflabor
Multiplevaginalexams
Meconiumstainedamnioticfluid
Epiduralanesthesia
Immunecompromisedstatus
Smoking,alcoholordrugabuse
Villitis
Viral,bacterialandprotozoalinfections
Obesityduringpregnancy
Multiplepregnancy(pregnantwithmorethanonebaby)
Urinarycomplicationsduringpregnancy

SIGNS AND SYMPTOMS OF CHORIOAMNIONITIS AND VILLITIS

Chorioamnionitis
Examinationofapregnantwomanwithchorioamnionitismayrevealnosignsorsymptomsof
infection.Ontheotherhand,apregnantwomanwithchorioamnionitismayappearill,toxic,and
shemayexhibithypotension(lowbloodpressure),diaphoresis(excessivesweating),and/orcool,
clammyskin.Maternalfever,however,isthemostimportantclinicalsignoftheinfection.
Signsandsymptomsofchorioamnionitisincludethefollowing:
Maternalfever
Diaphoresis
Uterinetenderness
Significantmaternaltachycardia(heartrate>120beats/min.)
Fetaltachycardia(heartrate>160180beats/min.)
Purulentorfoulsmellingamnioticfluidorvaginaldischarge
Maternalleukocytosis(highwhitebloodcellcount)
Theriskofneonatalsepsisisgreatlyincreasedwhenatleasttwooftheabovecriteriaarepresent.
Thesignsofvillitisarelistedbelow.
Chronicvillitis
ElevatedlevelsofalphafetoproteinwhenIUGRispresent
Nonsignificantelevationsofhumangrowthhormonewhentestingbiologicalscreeningof

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trisomy(abnormalnumberofchromosomes)inthesecondquarter
Acutevillitis
Abscessesintheplacentalparenchyma(villi)
Neutrophilicchorioamnionitis

DIAGNOSIS OF CHORIOAMNIONITIS AND VILLITIS

Chorioamnionitis
Chorioamnionitismaybediagnosedbasedonsignssuchasmaternalfever,microbiologically
basedonamnioticfluidcultureobtainedbyamniocentesis,orbymicroscopicexamofthe
umbilicalcordandplacenta.Thediagnosistypicallyismadebasedsolelyonclinicalsigns,
however,sinceaccesstouncontaminatedamnioticfluidorplacentaforcultureisinvasiveand
usuallyavoided.Thepresenceoffever(temperature>100.4)plustwoothersigns(uterine
tenderness,maternalorfetaltachycardiaandfoul/purulentamnioticfluid)isgenerallyrequired
fordiagnosis.Inaddition,thepresenceofriskfactorsofchorioamnionitis,especiallymembrane
rupture,furtherstrengthensdiagnosis.
Otherdiagnosticmethodsarelistedbelow.
Laboratorytestsforamotherwithnosymptomsandwhoisexperiencingprematurelaboror
PROMinclude:
Examinationofamnioticfluid
MaternalGBSscreeningtest
Maternalbloodstudies
Maternalurinestudies
Testingofafebrile(feverish)motherwithsuspectedchorioamnionitisincludes:
Whitebloodcellcounts
Creactiveproteinlevels
Alpha1proteinaseinhibitorcomplexmeasurement
Seruminterleukin6orferritinlevels
Studiestoevaluateamnioticfluidandurogenitalsecretionsinclude:
Bacterialcultures
Leukocytecount
Gramstaining
pH
Glucoseconcentration
Ultrasonographymaybeusedtodeterminethewellbeingofthebabyinthewomb.
Villitis
Villitisisusuallynotapparent(withoutamicroscope)unlessthereisabscessformation.
Abscessescantypicallybeseenwithanultrasound.
Villitisisassociatedwithplacentalinfectionsandthereforeshouldbeconsideredwhenanyofthe
followingconditionsarepresent:CMV,chorioamnionitis,candida,HSV,GBS,groupA
streptococcus,syphilis,toxoplasmosisandchlamydia.Itiscrucialthatphysicianspromptly
diagnoseandtreattheseinfectionsbecausewhenvillitisdevelops,thereisanincreasedriskfor
fetaldeath.

TREATMENT OF CHORIOAMNIONITIS AND VILLITIS

Chorioamnionitis
Treatmentforthemotherandbabywithchorioamnionitisincludesearlydelivery,supportivecare
andantibioticadministration.
Promptadministrationofantibioticsisessentialtopreventbothmaternalandfetalcomplications.
Timetodeliveryafterimplementingantibiotictherapyhasbeenshowntonotaffectmorbidities,
incertaincases.ThusCsectiontoexpeditedeliveryisnotindicatedforchorioamnionitisunless
thereareotherobstetricindications.Intravenous(IV)administrationofampicillinevery6hours
andgentamicinevery824hoursuntildeliveryisthestandardregimen.IfCsectionis
performed,clindamycinevery8hours(ormetronidazole)usuallyisaddedforanaerobic
coverage.TreatmentalsoshouldincludeadministrationofasingleIVadditionaldoseof
antibioticsafterdelivery.
Supportivemeasuresincludetheuseofacetaminophen(Tylenol),whichisespeciallyimportant
duringdeliverytopreventneonatalencephalopathy.
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Preventionofchorioamnionitis
Preventionofchorioamnionitisiscritical.PROM(orpretermPROM,PPROM)isamajorcause
ofchorioamnionitisupto70%ofwomenwhodevelopPROMwithcontractionsorlaborhave
chorioamnionitis.AlthoughPROMcancausechorioamnionitis,itmustbenotedthattogether
withpretermlabor,PROMfrequentlyiscausedbychorioamnionitis.
Thestandardforpreventionofchorioamnionitisistheadministrationofbroadspectrum
antibiotics,typicallyinvolvingerythromycinorazithromycin,andampicillinfor710daysviaIV
(2days)followedbyoralroutes.Laborinductionanddeliveryisassociatedwithreduced
maternalinfectionandneedforneonatalintensivecare.Whenthereisprolongedmembrane
rupture(>18hours)atterm,prophylacticantibioticsarenotindicatedifthemotherisnot
colonizedwithGBS.However,theCentersforDiseaseControl(CDC)recommendsinitiating
GBSprophylaxisifGBSstatusisunknown.
Indeed,prophylacticantibioticshavebeenshowntobeverybeneficialinreducingtheincidence
ofneonataldeath,chroniclungdiseaseormajorbrainabnormalitiesinthebaby.Antibioticsalso
havebeenshowntoreducetheincidenceofchorioamnionitisandneonatalsepsis,andtoprolong
timetodeliveryamongmotherswithpretermmembranerupturewhoaregivenexpectant
management(waitingforspontaneouslabor).
Villitis
Researchhasshownthatwhenvillitisissuspected,steroidsandaspirinduringpregnancyare
beneficial.Mostofthetime,thecauseofvillitisisunknown.However,sincevillitisisassociated
withplacentalinfections,asdiscussedabove,itisimperativethattheseinfectionsbeimmediately
diagnosedandtreated.

MEDICAL MALPRACTICE AND CHORIOAMNIONITIS / VILLITIS

Listedbelowareitemsthatmayconstitutenegligence:
Failuretodiagnoseandproperlytreatchorioamnionitis
FailuretodiagnosePROMandtofollowstandardsofcareinpreventionofascendinginfection
Failuretodiagnoseandproperlytreatplacentalinfections
Failuretocloselymonitorthemotherandbabywhenriskfactorsforchorioamnionitisand
villitisarepresent
Failuretoobtainadequateinformedconsent,whichincludesadvisingthemotheroftherisks
andalternativesofdeliverymethods,suchasvaginalbirthversusCsectionandexpectant
management
Failuretoobtainadequateinformedconsent,whichincludesadvisingthemotheroftherisks
andalternativesoftheuseofdeliveryinstruments,suchasforcepsandvacuumextractors
FailuretoproperlydeliverthebabyandtofollowstandardsofcarewhenperformingaC
sectionorvaginaldelivery,andwhenutilizingdeliveryinstruments
Whenriskfactorsforchorioamnionitisandvillitisarepresent,itisessentialthatthephysicians
monitorthemotherandbabyverycloselyandfollowguidelinesandmedicalstandardsofcarefor
treatmentandpreventionoftheinfections.Whenamother/babyarenotproperlytestedfor
placentalinfections,andwhenstandardsfortreatingtheconditionsarenotfollowed,itis
negligence.Ifchorioamnionitisandotherplacentalinfectionsarenotdiagnosedandtreatedright
away,veryseriousfetalandneonatalcomplicationscanarise.Whenthisnegligencecausesinjury
tothemotherorbaby,itismedicalmalpractice.

DO I HAVE A CHORIOAMNIONITIS / VILLITIS CASE?

Tofindoutifyouareeligibleforcompensation,contactourDetroitattorneyshandling
chorioamnionitisandvillitiscasesinMichigan,Ohio,Washington,D.C.andthroughoutthe
nation.AtReiter&WalshABCLawCenters,wearededicatedtobirthinjurycases.We
understandthecomplexlegalissuesinvolvedwithplacentalinfectioncasesandwillhelpyouto
obtainthecompensationtowhichyouareentitled.Callforafreecasereview:(888)419BABY.

LIVECHAT

Sources:
CornetteL.Fetalandneonatalinflammatoryresponseandadverseoutcome.SeminFetal
NeonatalMed20049:459.
LiebermanE,LangJ,RichardsonDK,etal.Intrapartummaternalfeverandneonataloutcome.
Pediatrics2000105:8.
SoperDE,MayhallCG,DaltonHP.Riskfactorsforintraamnioticinfection:aprospective
epidemiologicstudy.AmJObstetGynecol1989161:562.
FrigolettoFDJr,LiebermanE,LangJM,etal.Aclinicaltrialofactivemanagementoflabor.
NEnglJMed1995333:745.
NewtonER.Chorioamnionitisandintraamnioticinfection.ClinObstetGynecol199336:795.
YoonBH,RomeroR,MoonJB,etal.Clinicalsignificanceofintraamnioticinflammationin
patientswithpretermlaborandintactmembranes.AmJObstetGynecol2001185:1130.
RouseDJ,LandonM,LevenoKJ,etal.TheMaternalFetalMedicineUnitscesareanregistry:
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Reiter&WalshABCLawCentersChorioamnionitisandvillitisattorneysinMichigan,Ohio,WashingtonDC,andnationwide(888)419BABY

chorioamnionitisattermanditsdurationrelationshiptooutcomes.AmJObstetGynecol
2004191:211.
Kradin,RL.PerinatalInfections.In:DiagnosticPathologyofInfectiousDisease:ExpertConsult,
Saunders,2010.p.465.

Related Articles & Blogs from Reiter & Walsh ABC Law Centers
"Physiciansfailtodiagnosechorioamnionitisinawomanandfailtotimelydeliverherbaby:
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(HIE)."
"CerebralpalsycausedbyChorioamnionitis(Infection)."

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