Pathophysiology, diagnosis, and management of intraamniotic infection.

Intraamniotic infection (IAI) is a term used to describe a clinically diagnosed infection of the contents of the uterus. It is found most often after rupture of the membranes. The most useful diagnostic tests are physical examination, amniotic fluid glucose determination, and amniotic fluid Gram's stain. There is no clearly established means for the prevention of IAI, but cervical examinations and cervical manipulation can increase the risk, so caution with their use is still warranted. Treatment for this infection should be initiated when the diagnosis is made to provide the lowest risk of neonatal and maternal complications. Ampicillin or penicillin plus gentamicin are the most extensively tested antibiotics for treatment before delivery. Clindamycin or metronidazole should be added if a cesarean section is performed. As a general rule, antibiotics should be continued postpartum until the patient has been afebrile and asymptomatic for a minimum of 24 hours. Neonatal complications of IAI may be substantial especially for the premature fetus. Women with this infection have a greater risk for dysfunctional labor and cesarean section.