Intrauterine infection (chorioamnionitis)

What is an intrauterine infection?

An intrauterine infection is an infection inside your uterus (womb). During pregnancy it is called an ‘intra-amniotic infection’ or chorioamnionitis. The placenta, amniotic fluid or the membranes surrounding your baby may become infected.

An infection inside your uterus can also develop after your baby is born. This is called endometritis. It is an infection of the endometrium, which is the lining of your uterus.

What are the symptoms of an intrauterine infection?

Symptoms of an intrauterine infection include:

• fever — especially after your waters break, or during labour
• pain in your uterus
• vaginal discharge with an unpleasant smell or a green or yellow colour
• you and/or your baby having a fast heart rate

An intrauterine infection may start with mild, vague symptoms, but it can get worse quickly and make you and your baby very sick.

What can happen if I get an intrauterine infection?

An intrauterine infection can lead to you and your baby having complications.

It increases your risk of:

• postpartum haemorrhage
• other infections such as endometritis or a blood infection
• needing to have a caesarean birth
• blood clots
• placental abruption

It increases your baby’s risk of:

• being born preterm
• having a very low Apgar score
• infections such as pneumonia or meningitis
• cerebral palsy
• seizures

What causes an intrauterine infection?

Intrauterine infections are usually caused by bacteria from your vagina that move up into the uterus. This is most likely to occur after your waters break. When the protective sac around your baby tears, it allows bacteria to get in from outside.

Bacteria can get into your uterus during a procedure such as amniocentesis. Bacteria can also spread from your blood to your uterus through the placenta, but this is rare.

There may be several types of bacteria involved. Bacteria that can cause an intrauterine infection include:

• group B streptococcus
• escherichia coli
• listeria
• gonorrhoea

What can increase the risk of an intrauterine infection?

If it takes more than 24 hours from when your waters break until your baby is born, you have a higher risk of an intrauterine infection. Your risk is increased if your waters break before you go into labour — especially if this happens before you reach full term.

Your risk of an intrauterine infection is also higher if:

• you go into labour early
• you have a long labour
• your doctor or midwife performs repeated vaginal examinations after your waters have broken
• there is meconium (your baby’s poo) in the amniotic fluid
• you have bacteria in your vagina, such as group B streptococcus, bacterial vaginosis or gonorrhoea
• you smoke, drink alcohol or abuse drugs while you’re pregnant

When should I see my doctor or midwife?

Contact your doctor or midwife straight away if you think your waters have broken. They will examine you to see if this has happened and check that you and your baby are well.

You should contact your doctor or midwife immediately if you have a fever, pain in your uterus or an unusual vaginal discharge.

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How is an intrauterine infection diagnosed?

Your doctor may diagnose an intrauterine infection based on your symptoms. You might have blood tests and a vaginal swab to detect what type of bacteria is causing your infection.

After your baby is born, the placenta can be tested to confirm an intrauterine infection.

How is an intrauterine infection treated?

An intrauterine infection is treated urgently with antibiotics. You will receive 2 or 3 different types of antibiotics through a needle into your vein.

You will need to be admitted to hospital. You may also receive:

• fluids into your vein
• medicine to prevent blood clots
• paracetamol to lower your fever

It’s very important for your baby to be born as soon as possible, regardless of how many weeks pregnant you are. Your obstetric team will discuss with you whether they recommend an induction of labour or an emergency caesarean.

If you are less than 35 weeks pregnant, you may be given an injection of steroid medicine to help your baby’s lungs develop.

After your baby is born, you may need to continue antibiotics for up to 24 hours. Your baby will be closely monitored in hospital and might need antibiotics too.

Can I prevent getting an intrauterine infection?

If your waters break early, taking antibiotics can prevent an intrauterine infection. Your doctor will prescribe you antibiotics for 7 to 10 days.

If your waters break at full term before you go into labour, having an induction of labour can prevent an intrauterine infection. Antibiotics may prevent an infection, especially if you have group B streptococcus in your vagina or if you wait to go into labour naturally.

If your waters have broken, it’s also important to:

• use pads rather than tampons
• avoid sexual intercourse
• avoid having a bath — showering is OK
• avoid swimming

You can also prevent an intrauterine infection by:

• avoiding smoking, alcohol or drug use
• washing your vaginal area with plain soap and water and avoiding perfumed products
• getting tested for sexually transmitted infections if you’ve had unprotected sex

Will the infection affect my baby’s health?

It’s not always possible to predict which babies will have health problems from an intrauterine infection. However, if you are treated promptly with antibiotics, this will lower your baby’s risk. It’s best to give birth in a hospital that can provide the level of care your baby might need.

Your baby may develop an infection. The hospital staff will watch your baby’s health closely. If the risk is high, your baby might be given preventive antibiotics even if they are well.

If an intrauterine infection occurs before you reach full term, your baby will need to be born early. Learn more about health problems that may affect babies who are born early.

Will the infection affect how I give birth?

You will be advised to give birth as soon as possible if you have an intrauterine infection. Your doctor will talk to you about having an induced labour or an emergency caesarean. The safest option for you depends on your circumstances.

Your doctor might recommend fetal monitoring during labour, to check your baby is well and find any problems early.

Resources and support

Contact your doctor or midwife immediately if you think you may have an intrauterine infection.