ACUTE CHORIOAMNIONITIS IN A PRETERM TWIN PREGNANCY WITH FETAL COMPROMISE: RELEVANCE OF UROLOGIC-INFECTIOUS ASSESSMENT. A CASE REPORT
Keywords:
chorioamnionitis; preterm pregnancy; preterm prelabor rupture of membranes; twin pregnancy; urinary tract infection; pyelonephritis; fetal compromiseAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0901
Abstract
Introduction: Acute chorioamnionitis, currently framed within the spectrum of intra-amniotic infection or inflammation, is an obstetric emergency associated with preterm birth, maternal sepsis, fetal inflammatory response syndrome and fetal death. In pregnant patients with fever, prelabor rupture of membranes and abdominal pain, the diagnostic work-up should systematically consider extrauterine infectious sources, including urinary tract infection, because pyelonephritis and obstructive uropathy are associated with preterm birth and maternal-fetal morbidity. Case presentation: We report a 23.4-week monochorionic diamniotic twin pregnancy complicated by contraction-like pain, vaginal bleeding and fluid leakage. On admission, the patient had fever, maternal tachycardia, prolonged rupture of membranes and neutrophilic leukocytosis. Amniotic fluid examination showed abundant pyocytes, bacteria, Gram-positive cocci in pairs and absence of lactobacilli, supporting intra-amniotic infection. Lumbar examination did not reveal costovertebral-angle tenderness; nevertheless, the case emphasizes the need to document urinalysis, urine culture and renal ultrasound when maternal fever or urinary-source infection is suspected. After persistent leakage and clinical deterioration, fetal ultrasound confirmed absence of cardiac activity in both fetuses, and uterine evacuation was performed. Conclusion: Preterm chorioamnionitis with fetal compromise requires early diagnosis, broad-spectrum antimicrobial therapy, individualized obstetric decision-making and comprehensive infectious assessment. A urologic approach is relevant because complicated urinary tract infection and urinary tract obstruction may mimic, worsen or coexist with intra-amniotic infection.
Keywords: chorioamnionitis; preterm pregnancy; preterm prelabor rupture of membranes; twin pregnancy; urinary tract infection; pyelonephritis; fetal compromise.
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