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4/19/2015 Reiter&WalshABCLawCentersChorioamnionitisandvillitisattorneysinMichigan,Ohio,WashingtonDC,andnationwide(888)419BABY
http://www.abclawcenters.com/practiceareas/prenatalbirthinjuries/maternalinfections/chorioamnionitisandvillitis/ 1/5
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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
Chorioamnionitis,orintramnioticinfection,isaninflammationoftheplacenta/fetalmembranes(calledthechorionandamnion)causedbybacteriaascendingintotheuterusfromthevagina.Theascensionofbacteriaistypicallyassociatedwithprolongedlaborandmembranerupture(amotherswaterbreaking),butchoriomnionitiscanalsooccurwithintactmembranes.
Chronicchorioamnionitisiscommonlyassociatedwithvillitis,whichisinflammationofthechorionicvillisurfaceoftheplacenta.Chorionicvillideveloptomaximizesurfaceareacontactwithmaternalbloodfornutrientandgasexchangewithfetalblood.Villitisisveryserious,andwhentheconditionispresent,thechanceoffetaldeathisincreased.
Itiscrucialthatphysicianspromptlydiagnoseandtreatchorioamnionitisandtheinfectionsthatcanleadtovillitis.Ifadoctormishandlestreatment,theremaybedevastatingconsequencesforthebabyincluding:
Hypoxia(significantlyreducedoxygensupply)Hydropsfetalis(abnormalamountsoffluidbuildupintwoormorebodyareasofafetusornewborn)Intrauterinegrowthrestriction(IUGR)Prematureruptureofthemembranes(PROM)PretermbirthRespiratoryproblemsMeningitisEncephelopathy(braininjury,suchashypoxicischemicencephalopathy)Braindamage,suchascerebralpalsyandperiventricularleukomalacia(PVL)Neonatalsepsis(bloodinfection)Fetaldeath/stillbirth
Ifyouwerediagnosedwithchorioamnionitisoraninfectionthatledtovillitisandyourchildsustainedaseriousinjuryasaresult,pleasecalloneofthebirthinjuryattorneysatReiter&WalshABCLawCenters.Wewillreviewyourmedicalrecordsanddetermineifnegligenceexists.Wellletyouknowwhatyourlegaloptionsare.Callourofficeat(888)419BABY.
CAUSES OF CHORIOAMNIONITIS AND VILLITISChorioamnionitis
Inchorioamnionitis,infectiousorganismsarepassedfromthecolon,cervixandvaginatotheuterus,wherethebabyislocated.Specifically,thechorioamnionand/orumbilicalcordoftheplacentabecomeinfectedandinflamed.Lesscommonroutesofinfectionincludepassageofinfectiousorganismsduringamniocentesisorchorionicvilloussampling.Onceinfectedwithbacteria,thereisamaternalandfetalinflammatoryresponsethatmayleadtoreleaseofthehormoneprostaglandin,ripeningofthecervix,
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membraneinjury,andlaborattermorprematurely.
Villitis
Villitisisassociatedwithplacentalinfections.Thereareseveralconditionsthatcancausevillitis,butinmanycasesthecauseisunknown.
Bacterialcausesofvillitisincludethefollowing:
ChorioamnionitisStreptococciBacteriaassociatedwithmaternalsepsis
Viralcausesofvillitisinclude:
Cytomegalovirus(CMV)ToxoplasmosisHerpesRubellaSyphilis
RISK FACTORS FOR CHORIOAMNIONITIS AND VILLITISChorioamnionitis
PrematurelaborFetalmembranesthatareruptured(thewaterhasbroken)foraprolongedperiodProlongedlaborNulliparity(nopriorbirths)GroupBstreptococcus(GBS)Bacterialinfections,suchasurinarytractinfection(UTI),bacterialvaginosis(BV)andureaplasmaObesityduringpregnancyShortcervix(incompetentcervix)UseofthehormonevaginalprostaglandinduringlaborInternalmonitoringoflaborMultiplevaginalexamsMeconiumstainedamnioticfluidEpiduralanesthesiaImmunecompromisedstatusSmoking,alcoholordrugabuse
Villitis
Viral,bacterialandprotozoalinfectionsObesityduringpregnancyMultiplepregnancy(pregnantwithmorethanonebaby)Urinarycomplicationsduringpregnancy
SIGNS AND SYMPTOMS OF CHORIOAMNIONITIS AND VILLITISChorioamnionitis
Examinationofapregnantwomanwithchorioamnionitismayrevealnosignsorsymptomsofinfection.Ontheotherhand,apregnantwomanwithchorioamnionitismayappearill,toxic,andshemayexhibithypotension(lowbloodpressure),diaphoresis(excessivesweating),and/orcool,clammyskin.Maternalfever,however,isthemostimportantclinicalsignoftheinfection.
Signsandsymptomsofchorioamnionitisincludethefollowing:
MaternalfeverDiaphoresisUterinetendernessSignificantmaternaltachycardia(heartrate>120beats/min.)Fetaltachycardia(heartrate>160180beats/min.)PurulentorfoulsmellingamnioticfluidorvaginaldischargeMaternalleukocytosis(highwhitebloodcellcount)
Theriskofneonatalsepsisisgreatlyincreasedwhenatleasttwooftheabovecriteriaarepresent.
Thesignsofvillitisarelistedbelow.
Chronicvillitis
ElevatedlevelsofalphafetoproteinwhenIUGRispresentNonsignificantelevationsofhumangrowthhormonewhentestingbiologicalscreeningof
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4/19/2015 Reiter&WalshABCLawCentersChorioamnionitisandvillitisattorneysinMichigan,Ohio,WashingtonDC,andnationwide(888)419BABY
http://www.abclawcenters.com/practiceareas/prenatalbirthinjuries/maternalinfections/chorioamnionitisandvillitis/ 3/5
trisomy(abnormalnumberofchromosomes)inthesecondquarter
Acutevillitis
Abscessesintheplacentalparenchyma(villi)Neutrophilicchorioamnionitis
DIAGNOSIS OF CHORIOAMNIONITIS AND VILLITISChorioamnionitis
Chorioamnionitismaybediagnosedbasedonsignssuchasmaternalfever,microbiologicallybasedonamnioticfluidcultureobtainedbyamniocentesis,orbymicroscopicexamoftheumbilicalcordandplacenta.Thediagnosistypicallyismadebasedsolelyonclinicalsigns,however,sinceaccesstouncontaminatedamnioticfluidorplacentaforcultureisinvasiveandusuallyavoided.Thepresenceoffever(temperature>100.4)plustwoothersigns(uterinetenderness,maternalorfetaltachycardiaandfoul/purulentamnioticfluid)isgenerallyrequiredfordiagnosis.Inaddition,thepresenceofriskfactorsofchorioamnionitis,especiallymembranerupture,furtherstrengthensdiagnosis.
Otherdiagnosticmethodsarelistedbelow.
LaboratorytestsforamotherwithnosymptomsandwhoisexperiencingprematurelabororPROMinclude:
ExaminationofamnioticfluidMaternalGBSscreeningtestMaternalbloodstudiesMaternalurinestudies
Testingofafebrile(feverish)motherwithsuspectedchorioamnionitisincludes:
WhitebloodcellcountsCreactiveproteinlevelsAlpha1proteinaseinhibitorcomplexmeasurementSeruminterleukin6orferritinlevels
Studiestoevaluateamnioticfluidandurogenitalsecretionsinclude:
BacterialculturesLeukocytecountGramstainingpHGlucoseconcentration
Ultrasonographymaybeusedtodeterminethewellbeingofthebabyinthewomb.
Villitis
Villitisisusuallynotapparent(withoutamicroscope)unlessthereisabscessformation.Abscessescantypicallybeseenwithanultrasound.
Villitisisassociatedwithplacentalinfectionsandthereforeshouldbeconsideredwhenanyofthefollowingconditionsarepresent:CMV,chorioamnionitis,candida,HSV,GBS,groupAstreptococcus,syphilis,toxoplasmosisandchlamydia.Itiscrucialthatphysicianspromptlydiagnoseandtreattheseinfectionsbecausewhenvillitisdevelops,thereisanincreasedriskforfetaldeath.
TREATMENT OF CHORIOAMNIONITIS AND VILLITISChorioamnionitis
Treatmentforthemotherandbabywithchorioamnionitisincludesearlydelivery,supportivecareandantibioticadministration.
Promptadministrationofantibioticsisessentialtopreventbothmaternalandfetalcomplications.Timetodeliveryafterimplementingantibiotictherapyhasbeenshowntonotaffectmorbidities,incertaincases.ThusCsectiontoexpeditedeliveryisnotindicatedforchorioamnionitisunlessthereareotherobstetricindications.Intravenous(IV)administrationofampicillinevery6hoursandgentamicinevery824hoursuntildeliveryisthestandardregimen.IfCsectionisperformed,clindamycinevery8hours(ormetronidazole)usuallyisaddedforanaerobiccoverage.TreatmentalsoshouldincludeadministrationofasingleIVadditionaldoseofantibioticsafterdelivery.
Supportivemeasuresincludetheuseofacetaminophen(Tylenol),whichisespeciallyimportantduringdeliverytopreventneonatalencephalopathy.
4/19/2015 Reiter&WalshABCLawCentersChorioamnionitisandvillitisattorneysinMichigan,Ohio,WashingtonDC,andnationwide(888)419BABY
http://www.abclawcenters.com/practiceareas/prenatalbirthinjuries/maternalinfections/chorioamnionitisandvillitis/ 4/5
Preventionofchorioamnionitis
Preventionofchorioamnionitisiscritical.PROM(orpretermPROM,PPROM)isamajorcauseofchorioamnionitisupto70%ofwomenwhodevelopPROMwithcontractionsorlaborhavechorioamnionitis.AlthoughPROMcancausechorioamnionitis,itmustbenotedthattogetherwithpretermlabor,PROMfrequentlyiscausedbychorioamnionitis.
Thestandardforpreventionofchorioamnionitisistheadministrationofbroadspectrumantibiotics,typicallyinvolvingerythromycinorazithromycin,andampicillinfor710daysviaIV(2days)followedbyoralroutes.Laborinductionanddeliveryisassociatedwithreducedmaternalinfectionandneedforneonatalintensivecare.Whenthereisprolongedmembranerupture(>18hours)atterm,prophylacticantibioticsarenotindicatedifthemotherisnotcolonizedwithGBS.However,theCentersforDiseaseControl(CDC)recommendsinitiatingGBSprophylaxisifGBSstatusisunknown.
Indeed,prophylacticantibioticshavebeenshowntobeverybeneficialinreducingtheincidenceofneonataldeath,chroniclungdiseaseormajorbrainabnormalitiesinthebaby.Antibioticsalsohavebeenshowntoreducetheincidenceofchorioamnionitisandneonatalsepsis,andtoprolongtimetodeliveryamongmotherswithpretermmembranerupturewhoaregivenexpectantmanagement(waitingforspontaneouslabor).
Villitis
Researchhasshownthatwhenvillitisissuspected,steroidsandaspirinduringpregnancyarebeneficial.Mostofthetime,thecauseofvillitisisunknown.However,sincevillitisisassociatedwithplacentalinfections,asdiscussedabove,itisimperativethattheseinfectionsbeimmediatelydiagnosedandtreated.
MEDICAL MALPRACTICE AND CHORIOAMNIONITIS / VILLITISListedbelowareitemsthatmayconstitutenegligence:
FailuretodiagnoseandproperlytreatchorioamnionitisFailuretodiagnosePROMandtofollowstandardsofcareinpreventionofascendinginfectionFailuretodiagnoseandproperlytreatplacentalinfectionsFailuretocloselymonitorthemotherandbabywhenriskfactorsforchorioamnionitisandvillitisarepresentFailuretoobtainadequateinformedconsent,whichincludesadvisingthemotheroftherisksandalternativesofdeliverymethods,suchasvaginalbirthversusCsectionandexpectantmanagementFailuretoobtainadequateinformedconsent,whichincludesadvisingthemotheroftherisksandalternativesoftheuseofdeliveryinstruments,suchasforcepsandvacuumextractorsFailuretoproperlydeliverthebabyandtofollowstandardsofcarewhenperformingaCsectionorvaginaldelivery,andwhenutilizingdeliveryinstruments
Whenriskfactorsforchorioamnionitisandvillitisarepresent,itisessentialthatthephysiciansmonitorthemotherandbabyverycloselyandfollowguidelinesandmedicalstandardsofcarefortreatmentandpreventionoftheinfections.Whenamother/babyarenotproperlytestedforplacentalinfections,andwhenstandardsfortreatingtheconditionsarenotfollowed,itisnegligence.Ifchorioamnionitisandotherplacentalinfectionsarenotdiagnosedandtreatedrightaway,veryseriousfetalandneonatalcomplicationscanarise.Whenthisnegligencecausesinjurytothemotherorbaby,itismedicalmalpractice.
DO I HAVE A CHORIOAMNIONITIS / VILLITIS CASE?Tofindoutifyouareeligibleforcompensation,contactourDetroitattorneyshandlingchorioamnionitisandvillitiscasesinMichigan,Ohio,Washington,D.C.andthroughoutthenation.AtReiter&WalshABCLawCenters,wearededicatedtobirthinjurycases.Weunderstandthecomplexlegalissuesinvolvedwithplacentalinfectioncasesandwillhelpyoutoobtainthecompensationtowhichyouareentitled.Callforafreecasereview:(888)419BABY.
Sources:
CornetteL.Fetalandneonatalinflammatoryresponseandadverseoutcome.SeminFetalNeonatalMed20049:459.LiebermanE,LangJ,RichardsonDK,etal.Intrapartummaternalfeverandneonataloutcome.Pediatrics2000105:8.SoperDE,MayhallCG,DaltonHP.Riskfactorsforintraamnioticinfection:aprospectiveepidemiologicstudy.AmJObstetGynecol1989161:562.FrigolettoFDJr,LiebermanE,LangJM,etal.Aclinicaltrialofactivemanagementoflabor.NEnglJMed1995333:745.NewtonER.Chorioamnionitisandintraamnioticinfection.ClinObstetGynecol199336:795.YoonBH,RomeroR,MoonJB,etal.Clinicalsignificanceofintraamnioticinflammationinpatientswithpretermlaborandintactmembranes.AmJObstetGynecol2001185:1130.RouseDJ,LandonM,LevenoKJ,etal.TheMaternalFetalMedicineUnitscesareanregistry:
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4/19/2015 Reiter&WalshABCLawCentersChorioamnionitisandvillitisattorneysinMichigan,Ohio,WashingtonDC,andnationwide(888)419BABY
http://www.abclawcenters.com/practiceareas/prenatalbirthinjuries/maternalinfections/chorioamnionitisandvillitis/ 5/5
chorioamnionitisattermanditsdurationrelationshiptooutcomes.AmJObstetGynecol2004191:211.Kradin,RL.PerinatalInfections.In:DiagnosticPathologyofInfectiousDisease:ExpertConsult,Saunders,2010.p.465.
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