Chorioamnionitis in pregnancy

By trimester

Weeks 1–13

1st trimester

Chorioamnionitis is uncommon this early. Fever, severe pelvic or abdominal pain, foul discharge, or fluid leakage still needs prompt medical assessment because miscarriage-related infection and other urgent causes can present differently from infection during labor.

Weeks 14–27

2nd trimester

Before viability or after preterm membrane rupture, intra-amniotic infection may occasionally be suspected even without fever when purulent discharge, uterine tenderness, maternal fast heart rate, or abnormal laboratory findings are present. This requires urgent hospital assessment.

Weeks 28–birth

3rd trimester

Risk rises with prolonged rupture of membranes and labor. A temperature of at least 39 degrees Celsius, or 38.0 to 38.9 degrees with another clinical risk factor, supports suspected infection, but current guidance also recognizes selected afebrile presentations.

What does the evidence show for chorioamnionitis?

• ACOG's 2024 update states that suspected intra-amniotic infection is supported by maternal temperature of at least 39.0 degrees Celsius, or 38.0 to 38.9 degrees with an additional clinical risk factor. Infection may also be suspected without fever when other concerning signs are present, so fever is neither perfectly specific nor universally required. 1
• ACOG recommends intrapartum antibiotics when intra-amniotic infection is suspected or confirmed and says the condition alone is rarely a reason for cesarean birth. Communication with the neonatal care team is important because the newborn may need assessment after exposure. 2
• A multidisciplinary workshop emphasized that isolated maternal fever is not synonymous with infection. Epidural-associated fever, medications, dehydration, thyroid excess, and environmental heat are among alternative explanations, while fetal tachycardia, maternal leukocytosis, and purulent cervical fluid increase concern when fever is present. 3
• Clinical features may include fever, uterine tenderness, maternal or fetal tachycardia, and foul or purulent amniotic fluid. Maternal complications can include sepsis, postpartum uterine infection, and hemorrhage, while neonatal complications can include early-onset infection, so suspected cases require hospital care. 4
• ACOG advises that antibiotics given during labor should not automatically continue after birth. Postpartum continuation is based on factors such as birth route, persistent fever, or bacteremia, which means the care plan is individualized rather than a fixed course for every patient. 2

When should I call my provider about chorioamnionitis?

Go to the hospital or contact labor and delivery urgently for fever during labor, foul-smelling or pus-like fluid, new uterine tenderness, a racing heartbeat, fluid leakage with feeling ill, or concern that the fetal heart rate is unusually fast. Confusion, faintness, breathing difficulty, or rapidly worsening illness can signal maternal sepsis and require emergency care. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.