Patient handout

Chorioamnionitis / Intra-amniotic Infection (IAI) / Triple I

PRODUCTION

1. Your condition

This handout is for chorioamnionitis / intra-amniotic infection (iai) / triple i. Your care team identified this based on: intrapartum maternal fever — single ≥ 39.0 °c or 38.0-38.9 °c confirmed × 2 ≥ 30 min apart (higgins nichd/acog/smfm 2016 obstet gynecol 127:426).

Other reasons your team may use this plan: sustained fetal heart rate > 160 bpm for ≥ 10 min on continuous efm with maternal fever (higgins 2016; acog co 712 2017); maternal wbc > 15,000/µl without antenatal corticosteroid exposure + maternal fever (higgins 2016); purulent / foul cervical discharge on speculum exam with maternal fever (higgins 2016).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ampicillin	2 g IV	IV	q6h	Covers GBS, Listeria (cephalosporins do not), sensitive E. coli — ACOG CO 712 2017 first-line intrapartum
gentamicin	1.5 mg/kg IV q8h OR 5 mg/kg IV q24h (extended-interval)	IV	q8h or q24h	Gram-negative synergy with ampicillin; once-daily extended-interval also acceptable; ACOG CO 712 2017

Plan: Intrapartum + postpartum empiric antibiotics for chorioamnionitis / Triple I (ACOG CO 712 2017)

3. When to call your provider

Contact your care team if any of the following happen:

Postpartum fever / chills / uterine tenderness / foul lochia → endometritis workup (ED visit + broad-spectrum + imaging)
New mental health crisis (PHQ-9 ≥ 15 or suicidal ideation) → urgent mental health referral
Newborn high-risk features (persistent fever, poor feeding, irritability) → urgent peds visit / ED
Cesarean wound concern (erythema, dehiscence, purulent drainage) → urgent OB visit

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Chorioamnionitis + maternal qSOFA ≥ 2 OR SIRS ≥ 2 OR lactate ≥ 2 OR hypotension MAP < 65 — life-threatening maternal sepsis; routes to id.sepsis.core.v1 with OB-specific carryover. Broaden empirics (piperacillin-tazobactam or meropenem ± vancomycin) and emergent delivery (chorio source IS the gravid uterus).(life-threatening)
Chorio with antibiotics administered + persistent or progressive features + no delivery progress > 6 h post-antibiotic → consider cesarean. Each hour of delivery delay after chorio diagnosis correlates with increased maternal + neonatal morbidity (Tita Andrews 2010).
GBS-positive antepartum screen + inadequate intrapartum prophylaxis + maternal chorio → newborn at very high risk for early-onset GBS sepsis; mandatory newborn-care notification + neonatal empirics + sepsis surveillance per AAP Puopolo 2018; routes to id.neonatal-sepsis.early-late.v1.
Postpartum fever > 24-48 h OR uterine tenderness OR foul/purulent lochia → endometritis emerging; broaden anaerobic coverage; ddx retained products + abscess + cesarean wound infection
Preterm (< 37 wk) gestation + maternal chorio → neonatal workup mandatory due to elevated EOS + intraventricular hemorrhage + cerebral palsy + bronchopulmonary dysplasia risk; broaden neonatal empirics and admit NICU; routes to id.neonatal-sepsis.early-late.v1.
Severe chorio with pulmonary edema OR shock OR multi-organ dysfunction OR ARDS-pattern → ICU + broad-spectrum + emergent delivery + multidisciplinary critical care + OB + neonatology(life-threatening)
Cesarean delivery + chorio → extended 48 h IV antibiotic continuation postpartum + anaerobic add-on (clindamycin or metronidazole) for endometritis prevention; transition to PO not typically needed if course complete inpatient

5. Follow-up

Routine 6-week postpartum visit + chorio-specific anticipatory guidance: recurrence risk in subsequent pregnancy (~ 5-15%), microbiome / vaginal flora considerations (probiotic + targeted prevention research ongoing), mental health screen (PPD + postpartum-PTSD higher with peripartum complications), breastfeeding support, contraception counseling, immunization review (Tdap if not given, influenza, COVID per ACIP). Newborn outpatient: 24-48 h post-discharge peds visit if maternal chorio (high-risk follow-up).

6. Sources

Guideline: ACOG Committee Opinion 712 (2017, reaffirmed 2022) — Intrapartum Management of Intraamniotic Infection + Higgins RD et al, NICHD/ACOG/SMFM 2016 workshop (Obstet Gynecol 127:426; PMID 26855098) + ACOG Practice Bulletin 188 (2018) Prelabor Rupture of Membranes + ACOG Committee Opinion 797 (2020) Prevention of GBS Early-Onset Disease + WHO 2015 Recommendations for prevention and treatment of maternal peripartum infections + AAP Puopolo 2018 newborn EOS framework (PMID 30455342, 30455344) + CDC Verani 2010 GBS prevention (PMID 21088663) + SSC 2026 (sepsis-pathway carryover when maternal SIRS / qSOFA)