Intraamniotic infection (IAI) is a serious infection that complicates up to 13% of term labor. Definitive diagnosis of IAI requires the presence of both microbial infection and inflammatory markers such as neutrophils and cytokines in the amniotic cavity. Current microbiologic and diagnostic tests for inflammation take hours to days to return and, therefore, clinicians must rely on clinical signs to determine the need for treatment. Suspected IAI or “clinical chorioamnionitis” is defined as unexplained maternal fever (>38°C or 100.4°F) with one or more of the following symptoms or signs: 1) uterine tenderness and irritability; 2) leukocytosis; 3) fetal tachycardia; 4) maternal tachycardia; or 5) malodorous vaginal discharge. It is associated with significant morbidity for both the mother and neonate. Maternal complications include protracted labor, uterine atony, postpartum hemorrhage, wound infection, sepsis, and intensive care admission. Neonatal morbidity includes an increased risk for neonatal intensive care admission, pneumonia, meningitis, sepsis, and death. Prompt identification and treatment of intraamniotic infection with broad-spectrum antibiotics may decrease the morbidity associated with this infection. It is not an indication for immediate cesarean delivery, and standard obstetric guidelines should be followed to determine delivery route.

This case summarizes the management of a patient who presented for counseling 2 weeks after a stillbirth at 34 weeks’ gestation. Her pregnancy was uncomplicated until she developed prelabor rupture of membranes, leading to fetal demise. Placental pathology revealed findings suggestive of high-grade fetal vascular malperfusion, maternal vascular malperfusion, and severe ascending intrauterine infection. The most common placental abnormalities and their causes and associations are discussed as well as recommendations for further testing and future pregnancy management. Understanding placental histology following stillbirth allows for better support and preparation for future pregnancies.

Infections cause direct maternal morbidity and remain a leading cause of maternal morbidity in the United States and globally. In this chapter, we will discuss the physiologic considerations of infectious diseases in pregnancy, alterations in pregnancy response to infections, changes in immune cell populations, and fetal immune response. Pregnancy is a state of relative immunosuppression order for the maternal “host” to not reject fetus and this immunosuppression has consequences in the setting of infectious illness. The pathophysiology, epidemiology, obstetric management, antibiotic therapy, and anesthetic management of the most frequent bacterial and viral infections in the obstetric patient including chorioamnionitis, sepsis, human immunodeficiency virus (HIV), group A streptococcus, and TORCH infections. Additionally, we will present the obstetric and anesthetic management of uncommon bacterial, viral, and parasitic infections. This chapter provides nuanced understanding of peripartum immunologic physiology, an overview of common obstetrical infections, and a quick resource for uncommon as well as tropical infections, such as tuberculosis and malaria as they relate to pregnancy for obstetrics anesthesia providers. Management pearls included in this chapter can improve maternal and fetal outcomes for pregnant patients with infections illnesses.

During your call duty, a healthy 30-year-old primigravida at 40+4 weeks’ gestation, confirmed by first-trimester sonography, presents to the obstetric emergency assessment unit of your hospital center with possible spontaneous rupture of the chorioamniotic membranes after a two-day history of increased aching in the low back and coccyx. You recall meeting the patient at a routine prenatal visit at 32 weeks’ gestation while briefly covering your colleague’s practice; you ascertained all aspects of maternal-fetal care had been normal. Electronic health records indicate she has since remained compliant with obstetric care, which has been uncomplicated up to the latest prenatal visit three days ago.