A Clinical Analysis Of6Cases In Chorioamnionitis After Multi-fetal Pregnancy Reduction In Second Trimester

ObjectiveIn resent years, with the development of ART, the incidence of multi-fetal pregnancy becomes more and more increased, according with a series of problems. As a consequence, the reduction procedure has been widely used to remove the fetus with congenital malformation and decrease the number of embryos. Appropriate reduction can help to lower the incidence of abortion and premature birth, along with the lessened fetuses’ morbidity and mortality. However, as one of the complications, intrauterine infection especially chorioamnionitis always leads to serious outcomes such as premature rupture of membranes and even fetal death. Therefore, it’s necessary to discuss the clinical manifestations, pathological features, diagnosis and treatment in the patients, who suffered from chorioamnionitis after multi-fetal pregnancy reduction.MethodsWe retrospectively analyzed the clinical data of6cases suffered from chorioamnionitis after multi-fetal pregnancy reduction, including the history of pregnancy, the fetus number, the time of operation, the application of antibiotics, and associated clinical manifestation and checks, which are collected from obstetrics and gynecology department from Provincial hospital of Shandong University during from January in2007to October in2012.ResultsAll these6cases are all used antibiotics to prevent infection after the reduction procedure as routine.The major clinical manifestations of chorioamnionitis are high fever(>38℃), pressing pain on uterine, tachycardia of the mother and the fetus, offensive smell of amniotic fluid, increased amount of WBC etc.The above manifestations were all presented in these cases we collected. In the selected cases, the signs and symptoms of the chorioamnionitis after the reduction are mainly fever, abdominal pain, and water flowing from the vagina. Among them, there are4cases with fever as the starting symptom,1case with abdominal pain as the first symptom, and1case with the flowing water in the vagina for the starting symptom. The average time for the appearance of the clinical symptom is57.75hours.Coagulation markers vary dynamically before and after the onset of chorioamnionitis.Two of these cases are verified to have been infected by Klebsiella pneumoniae subspecies and Escherichia coli respectively.ConclusionThe multifetal pregnancy reduction operation has a risk of chorioamnionitis, which always leads to abortion and fetal death. Therefore it’s important to detect the abnormal clinical manifestations and laboratory reports in time.Kinds of causes can lead to the occurence of chorioamnionitis after the reduction operation, including the insufficiency of the fetal membrane, infection, multi-pregnancy and the release of the necrotic material after fetal death. Besides, the mental factors of the gravida also play an important role in promoting the chorioamnionitis.As a result, it is necessary for the medical stuff to master the indications and abide by the aseptic principle strictly. The emotion of the gravida should be considered too. Once the clinical signs of chorioamnionitis appear, the prompt treatment is necessary.Besides, it’s recommended that amniotic fluid can be delivered for bacterium culture before the operation.