A pragmatic approach to recognize intrapartum chorioamnionitis

• Published in: European journal of obstetrics & gynecology and reproductive biology 2024-12, Vol.305, p.199
• Main Authors: Pereira, Susana, Costa, Paulina, Oumar, Mohamed, Garcia-Ruiz, Itziar
• Format: Article
• Language: English
• Subjects: Cardiotocography; Chorioamnionitis; Fetal heart rate; Fetal inflammatory response; Funisitis; Intraamniotic infection; Intraamniotic inflammation
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.12.012

•Chorioamnionitis is a significant contributor to non-hypoxic fetal compromise and poor neonatal outcomes.•Microbial and nonmicrobial triggers can cause an inflammatory response in the amniotic cavity the mother, and the fetus.•Diagnostic methods for chorioamnionitis based on clinical signs, histopathology or laboratory results are often delayed, missing early signs of fetal inflammatory response.•An increase in fetal heart rate without preceding decelerations, due to an increase in fetal metabolic rate is observed in the initial stage of the inflammatory response.•Cardiotocography is a real-time tool that allows an early recognition of chorioamnionitis by displaying features that illustrate the progression of the fetal inflammatory response. Chorioamnionitis is a significant contributor to non-hypoxic fetal compromise, increasing the risk of neonatal encephalopathy and cerebral palsy. This paper highlights the limitations of traditional diagnostic methods for chorioamnionitis, which rely on histopathology, microbiology, and clinical signs, and emphasizes the importance of recognizing the fetal inflammatory response using intrapartum cardiotocography (CTG). By understanding the physiological pathways of inflammation, clinicians can identify characteristic CTG patterns. This pragmatic approach allows for earlier detection and intervention, potentially improving perinatal outcomes. The paper calls for a re-evaluation of clinical management practices and advocates for a multifaceted approach that incorporates CTG findings into the diagnosis of chorioamnionitis to prevent adverse neonatal outcomes.