Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis

TLDR

In January 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened an expert panel to address knowledge gaps and develop evidence‑based guidelines for diagnosing and managing pregnant women and newborns with the condition historically called chorioamnionitis, noting that the term has encompassed a heterogeneous array of infection and inflammation‑related conditions leading to variable clinical practice. The workshop’s purpose was to refine the definition and management of this complex group of conditions and to propose a research agenda for further study. The panel replaced the term chorioamnionitis with the descriptive term “Triple I” (intrauterine inflammation, infection, or both), defined a classification, and recommended evaluation and management approaches, which this article summarizes. An isolated maternal fever is not synonymous with chorioamnionitis; the condition is redefined as “Triple I” (intrauterine inflammation, infection, or both).

Abstract

In Brief In January 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited an expert panel to a workshop to address numerous knowledge gaps and to provide evidence-based guidelines for the diagnosis and management of pregnant women with what had been commonly called chorioamnionitis and the neonates born to these women. The panel noted that the term chorioamnionitis has been used to label a heterogeneous array of conditions characterized by infection and inflammation or both with a consequent great variation in clinical practice for mothers and their newborns. Therefore, the panel proposed to replace the term chorioamnionitis with a more general, descriptive term: “intrauterine inflammation or infection or both,” abbreviated as “Triple I.” The panel proposed a classification for Triple I and recommended approaches to evaluation and management of pregnant women and their newborns with a diagnosis of Triple I. It is particularly important to recognize that an isolated maternal fever is not synonymous with chorioamnionitis. A research agenda was proposed to further refine the definition and management of this complex group of conditions. This article provides a summary of the workshop presentations and discussions. Clinical chorioamnionitis is redefined as “Triple I” (intrauterine inflammation, infection, or both).