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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.
Epidurals are the most effective mode of analgesia for labor pain. Neurological complications, although rare, remain one of the most important causes of anxiety in the parturient and it is important to provide reassurance while providing accurate data for informed consent. Central nervous system (CNS) lesions secondary to epidural analgesia are very rare. They can be classified into four etiologies: traumatic, ischemic, infective, or chemical, or can sometimes be a combination thereof. High-quality evidence supports that there is no causal relationship between epidural labor analgesia and the development of new chronic back pain. High-dose epidural fentanyl may be associated with an adverse effect on breastfeeding. Women who labor with epidural analgesia experience an increase in temperature, which is associated with administration of antibiotics to both mother and babies, increased neonatal sepsis workups, as well as possibly increased operative deliveries.
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