Lukanović David, Batkoska Marija, Kavšek Gorazd, Druškovič Mirjam
Division of Obstetrics and Gynecology, Ljubljana University Medical Center, Ljubljana, Slovenia.
Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Front Med (Lausanne). 2023 May 24;10:1191254. doi: 10.3389/fmed.2023.1191254. eCollection 2023.
Intraamniotic infection is an infection resulting in the inflammation of any combination of the amniotic fluid, the placenta, the fetus itself, the fetal membranes, umbilical cord, or the decidua. In the past, an infection of the amnion and chorion or both was dubbed . In 2015, a proposal was made by an expert panel that, instead of , the name be used, abbreviated as or simply . However, the abbreviation did not gain popularity, and this article uses the term . Chorioamnionitis may arise prior to, during, or following labor. It can present as a chronic, subacute, or acute infection. Its clinical presentation is generally referred to as . The treatment of chorioamnionitis varies widely across the world due to different bacterial causes and the absence of sufficient evidence to support a specific treatment regimen. There are limited randomized controlled trials that have evaluated the superiority of antibiotic regimens for treating amniotic infections during labor. This lack of evidence-based treatment suggests that the current choice of antibiotics is based on limitations in existing research, rather than absolute science. Chorioamnionitis cannot be cured by antibiotic therapy alone without delivery, and therefore it is necessary to make a decision according to the guidelines for induction of labor or acceleration of delivery. When a diagnosis is suspected or established, it is therefore necessary to apply broad-spectrum antibiotics according to the protocol used by each country, and to continue with them until delivery. A commonly recommended first-line treatment for chorioamnionitis is a simple regimen consisting of amoxicillin or ampicillin and once-daily gentamicin. Available information is not sufficient to indicate the best antimicrobial regimen to treat this obstetric condition. However, the evidence that is currently available suggests that patients with clinical chorioamnionitis, primarily women with a gestational age of 34 weeks or more and those in labor, should receive treatment with this regime. However, antibiotic preferences may vary based on local policy, clinician experience and knowledge, bacterial reasons for the infection, antimicrobial resistance patterns, maternal allergies, and drug availability.
羊膜腔内感染是一种导致羊水、胎盘、胎儿自身、胎膜、脐带或蜕膜中任何一种或多种发生炎症的感染。过去，羊膜和绒毛膜或两者的感染被称为 。2015年，一个专家小组提议，不用 ，而使用 这个名称，缩写为 或简称为 。然而，缩写 并未流行起来，本文使用术语 。绒毛膜羊膜炎可在分娩前、分娩期间或分娩后出现。它可表现为慢性、亚急性或急性感染。其临床表现通常被称为 。由于细菌病因不同且缺乏支持特定治疗方案的充分证据，世界各地对绒毛膜羊膜炎的治疗差异很大。评估分娩期间治疗羊水感染的抗生素方案优越性的随机对照试验有限。这种缺乏循证治疗的情况表明，目前抗生素的选择是基于现有研究的局限性，而非绝对科学。绒毛膜羊膜炎不进行分娩仅靠抗生素治疗无法治愈，因此有必要根据引产或加速分娩的指南做出决定。因此，当怀疑或确诊时，有必要根据每个国家使用的方案应用广谱抗生素，并持续使用至分娩。绒毛膜羊膜炎常用的一线推荐治疗方案是一种简单的方案，由阿莫西林或氨苄西林和每日一次的庆大霉素组成。现有信息不足以表明治疗这种产科疾病的最佳抗菌方案。然而，目前可得的证据表明，患有临床绒毛膜羊膜炎的患者，主要是孕周34周或以上且正在分娩的女性，应接受该方案的治疗。然而，抗生素的偏好可能因当地政策、临床医生的经验和知识、感染的细菌原因、抗菌药物耐药模式、产妇过敏情况以及药物可及性而有所不同。
