QuestionSBA
QuestionChoice
Whilst chromosomal abnormalities are a common cause of spontaneous miscarriage, this mother has other features that point toward an infective cause.
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e
Chromosomal abnormality
QuestionChoice
Despite the maternal vomiting, gastroenteritis is a less likely cause of foetal demise. Gastroenteritis rarely causes sepsis or uterine activity.
49883
b
Gastroenteritis
QuestionChoice
Chorioamnionitis is a common cause of second trimester miscarriage and typically occurs due to ascending infection from the vagina. Chorioamnionitis typically presents with maternal fever, tachycardia and abdominal pain. There may be an offensive vaginal discharge or preterm prelabour rupture of membranes. In some cases, it leads to foetal demise.
49882
a
Chorioamnionitis
QuestionChoice
Whilst urinary tract infection is the most common type of infection in pregnancy, there are no signs or symptoms of urinary tract infection.
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c
Urinary tract infection
QuestionChoice
Preterm rupture of membranes at 19 weeks would likely result in foetal demise, however in this scenario there is no indication that the membranes have ruptured.
49885
d
Preterm rupture of membranes
QuestionComment
i dont understand there is no evidence of premature rupture of membranes
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QuestionComment
Dont need it bro just makes it more likely 
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# Summary

Chorioamnionitis is an infection of the membranes in the uterus and is typically characterized by fever, abdominal pain, offensive vaginal discharge, and signs of preterm rupture of membranes. Key signs include maternal and foetal tachycardia, pyrexia and uterine tenderness. Investigation typically involves blood tests and cultures. Management includes hospital admission, delivery, and intravenous broad spectrum antibiotic therapy.


# Definition



Chorioamnionitis, also referred to as intra-amniotic infection (IAI), is a bacterial infection that affects the membranes surrounding the fetus (the amniotic sac) and the amniotic fluid within the uterus. 


# Epidemiology



Chorioamnionitis affects approximately 1-4% of all births and is commonly associated with premature delivery. 


# Aetiology



The infection is often caused by bacteria ascending from the vagina into the uterus, with the most common organisms being Group B streptococcus, E. coli, and anaerobic bacteria.


# Signs and Symptoms



Patients with chorioamnionitis typically present with the following symptoms and signs:

- Fever
- Abdominal pain
- Offensive vaginal discharge
- Evidence of preterm rupture of membranes
- Maternal and foetal tachycardia
- Pyrexia
- Uterine tenderness


# Differential Diagnosis



The main differentials for chorioamnionitis include:

- Urinary tract infection: presents with dysuria, frequency, urgency, suprapubic pain, and possibly pyrexia.
- Appendicitis: presents with right lower quadrant pain, nausea, vomiting, and possibly fever.
- Placental abruption: presents with vaginal bleeding, abdominal pain, and rigid uterus.

# Investigations


The diagnosis of chorioamnionitis is commonly established by clinical signs and symptoms. However, laboratory investigations including blood tests and cultures, can be used to confirm the diagnosis and identify the causative organism. 

# Management


Chorioamnionitis is an indication for hospital admission and delivery. Management includes:

- Intravenous broad spectrum antibiotic therapy as part of the sepsis six protocol.
- Monitoring of both mother and foetus for complications.
- In some cases, early delivery may be necessary to prevent further complications.

# References



[RCOG guidelines on bacterial infection in pregnancy ](https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_64a.pdf)

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A 23-year-old woman presents to accident and emergency at 19 weeks gestation with severe abdominal pain and vomiting.


Her observations are as follows:


 - Heart rate: 140 beats per minute
 - Blood pressure: 108/72mmHg
 - Respiratory rate: 20 breaths per minute
 - SpO2: 99% on room air
 - Temperature 38.1°C


Her full blood count tests are as follows:


||||
|--------------|:-------:|---------------|
|Haemoglobin|126 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|16.7x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|450x10<sup>9</sup>/L|150 - 400|



An abdominal examination reveals a gravid uterus with diffuse abdominal tenderness. There is sporadic uterine activity.


A midwife attends who is unable to auscultate the foetal heart.


A transabdominal ultrasound scan confirms a non-viable pregnancy with no foetal heart.


What is the most likely cause for this foetal demise?
a