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A 29-year-old woman presents to the labor floor with painful contractions at term. She has no known drug allergies. She is found to have spontaneously ruptured her membranes but is not in active labor. She is admitted for induction and develops fever intrapartum with fetal and maternal tachycardia. You treat her with antibiotics and monitor her labor curve. She eventually meets the criteria for arrest of dilation and is on call to the operating room for primary cesarean section. Which of the following antibiotics should you add to her regimen?
Intra-amniotic infection can affect all intrauterine contents, such as amniotic fluid, placenta, fetus, and decidua. It is polymicrobial and is typically an ascending infection caused by vaginal flora. Instrumentation such as intrauterine catheters and fetal scalp electrodes and frequent vaginal examinations increase the risk of infection. Appropriate diagnosis and treatment should be initiated due to the increased neonatal risk of intra-amniotic infection, such as neonatal pneumonia, meningitis, sepsis, and death. The diagnosis of intra-amniotic infection is primarily clinical, as a definitive diagnosis is most commonly obtained after delivery. Maternal fever is commonly present, and other major clinical criteria include maternal leukocytosis, purulent cervical drainage, and fetal tachycardia. In women without known drug allergies, the recommended antibiotic regimen comprises ampicillin and gentamicin. Alternatives can be considered in the setting of mild or severe penicillin allergy. When the route of delivery changes to cesarean, the addition of clindamycin is recommended to improve anaerobic coverage.
Cefazolin (A) is not warranted, since the treatment for intra-amniotic infection already covers skin flora and is sufficient for prophylaxis. Gentamicin (C) is already part of the regimen for treatment of intra-amniotic infection. Vancomycin (D) is recommended in women with severe penicillin allergy and group B streptococci colonization.
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Intra-amniotic Infection (Chorioamnionitis)
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