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Infections in Pregnancy

Chorioamnionitis / Intra-amniotic Infection

IN REVIEWv3🌍 International referencePENDING CLINICAL VERIFICATION
Fever >=38 intrapartum or maternal/fetal tachycardia+foul liquor: antibiotics NOW + expedite birth. Ampicillin+gentamicin(+metronidazole post-CS). Neonatal team alerted.

Admission & discharge ↓

Reviewer note: Medication regimens and dependent emergency instructions checked 17 October 2026. These targeted checks do not certify every statement in the module. Admission/discharge guidance checked 18 October 2026. This adds a scoped clinical synthesis and does not certify every statement in the module.

Admission & discharge

Care setting: Inpatient obstetric infection/birth pathway

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Admit suspected infection and assess for maternal sepsis, fetal compromise and the need for birth/source control.

When clinic, day care or home care may be suitable

  • Suspected intra-amniotic infection is not a home-observation diagnosis.

Before going home

  • After birth/source control, maternal condition and observations are improving with no unresolved sepsis or obstetric complication.
  • The neonatal team has received the infection, antibiotic and membrane-rupture history and made the baby’s separate observation/treatment plan.

Discharge medicines and treatment changes

  • Document the actual antimicrobial indication, culture results and whether further post-birth therapy is needed; prolonged home antibiotics are not automatic for every treated chorioamnionitis case.

Tests, pending results and their reviewer

  • Assign culture/pathology review and repeat maternal organ/blood tests if abnormal.

Home care and counselling

  • Give postpartum infection and bleeding warnings, feeding support and a contact route; explain any neonatal stay.

Follow-up: when and what to review

WhenAction / responsible service
Before leaving
Name the reviewer of outstanding microbiology and any antibiotic stop/review decision.
At early postnatal contacts
Review fever, pain, lochia, wound status and maternal/newborn recovery.

Return urgently

  • Fever/rigors, offensive lochia, worsening abdominal/wound pain, heavy bleeding, faintness or newborn illness requires urgent reassessment.

Open the complete discharge checklist →

Sources for this plan:
Ministry of Health MalaysiacheckedNICE · NG255checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarychecked

Treatment

① Immediate stabilization — first minutes
  • Start antibiotics immediately on suspicion - do NOT await cultures
  • Expedite birth decision (induction/augment vs CS by obstetric picture)
③ First-line treatment & drug regimens

Select a source-specific combination from the complete drug cards below. Ampicillin and gentamicin are combination partners; caesarean/anaerobic cover and postpartum duration must be prescribed explicitly.

④ Drug treatment detail (3 agents)
Ampicillin — chorioamnionitis componentMinistry of Health Malaysiachecked
Dose2 g
RouteIV infusion
FrequencyEvery 6 hours
DurationContinue through birth with postpartum review; the cited Malaysian NAG continues until afebrile/asymptomatic ≥48 h. Other national protocols shorten postpartum treatment after clinical recovery
PreparationReconstitute the actual vial per label; dilute each adult dose in 100 mL sodium chloride 0.9% or glucose 5% and infuse over 30 min. Use a separate line/flush from gentamicin
Max dose8 g/day in this 2 g every-6-h regimen; renal impairment requires adjustment
  • Indication: Intra-amniotic infection, in combination with gentamicin; add anaerobic cover for caesarean according to the chosen guideline
  • This is not GBS prophylaxis and is not ampicillin monotherapy. The postpartum duration differs between guidelines; record the local choice explicitly.
Monitoring
  • Temperature, pulse, BP, uterine tenderness, fetal heart rate, cultures and renal function
Contraindications: Penicillin anaphylaxis; check severe delayed beta-lactam reactions
Gentamicin — obstetric infection componentMSFchecked
Dose5 mg/kg using the approved aminoglycoside dosing weight
RouteIV infusion
FrequencyEvery 24 h initially if renal function allows; subsequent interval depends on drug levels and renal function
DurationDaily review; limit unnecessary exposure, stop or narrow after source control and clinical recovery. Duration follows the infection, not a universal 48–72 h rule
Preparation40 mg/mL stock: volume in mL = prescribed mg ÷40. Dilute the adult dose in 100 mL sodium chloride 0.9%/glucose 5%; infuse over 30 min. Use a separate line/flush from beta-lactams
Max doseWeight-based; do not apply total body weight uncritically in obesity. Withhold/review further doses for accumulating levels or renal deterioration
  • Indication: Combination therapy for chorioamnionitis, postpartum endometritis or septic miscarriage
  • Renal / hepatic: Adjust interval/dose to renal function and measured levels; do not keep automatic daily dosing in AKI
Monitoring
  • Baseline and serial creatinine/urine output; drug-level monitoring using the hospital once-daily schedule
  • Ask about tinnitus, hearing change or vertigo; stop and review suspected ototoxicity
Contraindications: Aminoglycoside allergy; myasthenia gravis, AKI, prior auditory/vestibular toxicity require specialist assessment
Metronidazole — obstetric anaerobic coverMSFchecked
Dose500 mg
RouteIV infusion
FrequencyEvery 8 hours
DurationReview daily and switch to oral when feasible; duration is source-specific: uncomplicated infection recovery versus septic miscarriage (10–14 days in Malaysian NAG)
PreparationReady-to-use 500 mg/100 mL (5 mg/mL) bag infused over 30 min; do not add other drugs to the bag
Max dose1.5 g/day in this regimen; severe hepatic impairment requires reduction
  • Indication: Combination treatment of selected septic miscarriage/endometritis or caesarean chorioamnionitis
  • Renal / hepatic: In severe hepatic impairment the cited MSF monograph reduces the daily dose to one third
Monitoring
  • Clinical response, LFTs in prolonged treatment, interacting anticoagulants and neuropathy with prolonged exposure
Contraindications: Nitroimidazole allergy; severe hepatic impairment requires a reduced regimen
Monitoring
  • Hourly obs; CTG continuous; placenta histology at birth
⑮ Complications & their management
Neonatal sepsis

Paediatric workup at delivery

PPH

Infected uterus contracts poorly - PPH bundle ready

Post-treatment care
  • Complete antibiotic course; lactation continues safely

Diagnosis & assessment

Red flags:
  • Haemodynamic instability -> sepsis pathway

Initial assessment

See treatment table for testing and regimens.

Principles & follow-up

Management principles

Sources (9)

Ministry of Health Malaysia — National Antimicrobial Guideline — Obstetric and gynaecological infections
· checked 2026-10-18 · verified-live
Open source ↗

Source-specific combinations and durations for chorioamnionitis, endometritis and septic miscarriage; GBS ampicillin 2 g then 1 g every 4 h until delivery. Regional guidance is labelled; local resistance and culture review remain required. Additional admission/discharge check 18 October 2026 (limite…

MSF — Gentamicin injectable
· checked 2026-10-17 · verified-live
Open source ↗

Adult 5–6 mg/kg daily, 40 mg/mL presentation, 100 mL adult infusion over 30 minutes and renal/ototoxicity/compatibility precautions; obstetric combination choice from the national infection guideline.

MSF — Metronidazole injectable
· checked 2026-10-17 · verified-live
Open source ↗

500 mg/100 mL over 30 minutes, every-8-hour adult dosing, switch to oral, severe hepatic reduction and interactions. Syndrome duration supplied separately by the infection guideline.

NICE — NG255 — managing suspected sepsis in pregnant or recently pregnant people
19 November 2025 · checked 2026-10-18 · verified-live
Open source ↗

Scope: additional clinical-detail explanation for maternal-sepsis. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge …

NICE — Postnatal care — NG194
· checked 2026-10-18 · verified-live
Open source ↗

Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.

India MoHFW / NHM — District Hospital Standard Operating Procedures — LaQshya
· checked 2026-10-18 · verified-live
Open source ↗

Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.

WHO — WHO recommendations on quality postnatal care — official recommendation summary
· checked 2026-10-18 · verified-live
Open source ↗

Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.

RCOG — Laparoscopy — recovering well
· checked 2026-10-18 · verified-live
Open source ↗

Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…

NICE — Acutely ill adults in hospital — CG50
· checked 2026-10-18 · verified-live
Open source ↗

Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.