Chorioamnionitis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain. Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period. Extrauterine infections should be considered in patients with fever and abdominal pain. And lastly, noninfectious conditions such as placental abruption should be considered in patients with abdominal pain in the absence of fever.
Differentiating Chorioamnionitis From Other Diseases
Chorioamnionitis must be differentiated from other conditions that cause maternal fever, abdominal pain, or maternal/fetal tachycardia such as epidural-related fever, extrauterine infections, and noninfectious conditions characterized by abdominal pain.[1]
- Epidural-related fever should be considered in patients with epidural anesthesia who have low grade fever without maternal/fetal tachycardia during the intrapartum period.
- Extrauterine infections should be considered in patients with fever and abdominal pain. Extrauterine infections that must be differentiated from chorioamnionitis include:
- Appendicitis
- Pneumonia
- Influenza
- Pyelonephritis and other urinary tract infections
- Noninfectious conditions should be considered in patients with abdominal pain in the absence of fever. Noninfectious conditions that must be differentiated from chorioamnionitis include:
- Thrombophlebitis
- Placental abruption
- Colitis
- Connective tissue disorders
- Round ligament pain
Chorioamnionitis, must be differentiated from other diseases that may cause, fever, abdominal pain, and maternal/fetal tachycardia. The table below, summarizes the differential diagnosis for chorioamnionitis:
| Disease | Findings |
|---|---|
| Epidural-Related Fever | Intrapartum fever (≥38 °C), Absence of other clinical findings of intrauterine inflammation (abdominal pain, maternal/fetal tachycardia, etc.)[2][1] |
| Appendicitis | Presents with abdominal pain that begins around the umbilicus, then migrates to the right lower quadrant (relatively rare but also possible at right upper quadrant), nausea vomiting, abdominal guarding, deep tenderness at MBburney's point, dysuria[3] |
| Pneumonia | Presents with fever, productive cough, pleuritic chest pain, dyspnea, rigor, perspiration, and findings on auscultation such as inspiratory rales localized to the affected area |
| Influenza | Presents with acute fever, headache, cough, rigor, perspiration, myalgias, and malaise[4] |
| Pyelonephritis | Presents with fever, chills, malaise, dysuria, urinary urgency, polyuria, nausea, flank pain[5] |
| Others | Thrombophlebitis, placental abruption, colitis, connective tissue disorders, and round ligament pain can produce abdominal pain that may be confused with chorioamnionitis. However, the absence of fever indicates these conditions rather than chorioamnionitis.[1] |
References
- ↑ 1.0 1.1 1.2 Tita AT, Andrews WW (June 2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
- ↑ Jansen S, Lopriore E, Naaktgeboren C, Sueters M, Limpens J, van Leeuwen E, Bekker V (2020). "Epidural-Related Fever and Maternal and Neonatal Morbidity: A Systematic Review and Meta-Analysis". Neonatology. 117 (3): 259–270. doi:10.1159/000504805. PMID 31991422.
- ↑ Franca Neto AH, Amorim MM, Nóbrega BM (2015). "Acute appendicitis in pregnancy: literature review". Rev Assoc Med Bras (1992). 61 (2): 170–7. doi:10.1590/1806-9282.61.02.170. PMID 26107368.
- ↑ Gaitonde DY, Moore FC, Morgan MK (December 2019). "Influenza: Diagnosis and Treatment". Am Fam Physician. 100 (12): 751–758. PMID 31845781.
- ↑ Johnson JR, Russo TA (January 2018). "Acute Pyelonephritis in Adults". N Engl J Med. 378 (1): 48–59. doi:10.1056/nejmcp1702758. PMID 29298155.