Intrauterine infection is infection within the womb, which, in the context of pregnancy, usually means infection of:
- the membranes that surround the baby
- the umbilical cord
- and/or the amniotic fluid.
Research suggests that intrauterine infection may be responsible for as many as 40 percent of preterm births, with higher rates in earlier gestations (very premature babies).
What is intrauterine infection?
The womb, amniotic fluid and the environment in which the baby develops can become infected with bacteria. These are usually natural bacteria that many women carry in the vagina or skin, which are harmless normally, but have migrated to parts of the body where they shouldn't be. The most common cause of intrauterine infection is through the vagina and cervix, but it can also come through the placenta, through the fallopian tubes or via invasive procedures such as amniocentesis.
Infections that could ascend to the womb include E-Coli and Group B Streptococcus (GBS), bacterial vaginosis, chlamydia, trichomona, gonorrhoea, syphilis and HIV.
If the infection reaches the womb it can cause the fetal membranes (membrane of the sac that surrounds a baby in the womb, also called amnion or chorion) to become inflamed and infected. This is called chorioamnionitis. If the umbilical cord is affected it is called funisitis.
What are the effects of chorioamnionitis?
This is an infection of the membranes of the sac that holds a baby and the waters, and usually occurs when an undetected infection progresses up into the womb from the vagina. The infection causes the membranes to become inflamed and this may in itself trigger preterm contractions. It could also cause the waters to break early (also known as preterm premature rupture of the membranes, or PPROM for short). The baby may need to be born soon to prevent a more serious infection.
Look out for these symptoms of chorioamnionitis:
- high temperature
- a foul-smelling vaginal discharge
- fast pulse rate
- pain in your abdomen.
If you have any of these symptoms, seek advice from your healthcare team as soon as possible as you may need treatment.
Urinary tract infections (UTIs)
Often caused by the E-Coli bug, UTIs affect about five percent of pregnant women. In between one third and a half of those women, the UTI will travel up into the kidneys, causing acute pyelonephritis, a kidney infection that can cause premature labour and low birthweight. Watch out for these symptoms of UTIs:
- high fever
- pain in your sides or lower back
- discomfort or pain when passing urine
- blood in the urine
If you have any of these symptoms, contact your healthcare team as soon as possible as you may need antibiotics.
Treatment for infections
It is not always easy to spot an infection; in the early stages there may be no obvious symptoms. If there is any indication of an infection, for example if you are running a fever, your healthcare team will test you with either a blood test or a simple swab.
If your waters break early (PPROM), you may be given antibiotic tablets as a matter of course, to reduce the risk of chorioamnionitis.
If the infection has progressed beyond a certain point, or if you are very unwell you may need to be admitted to hospital for intravenous antibiotics and in some cases the baby may need to be delivered. In most cases of PPROM, taking antibiotics helps to reduce the likelihood of chorioamnionitis, reduces the number of births happening within 48 hours of waters breaking, and reduces the chances of the baby developing an infection.
J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders
Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance
Kim, Chong Jai et al. American Journal of Obstetrics & Gynecology , Volume 213 , Issue 4 , S29 - S52
BMJ Best Practice (accessed Oct 2016) http://bestpractice.bmj.com/best-practice/monograph/671/diagnosis/histor...
Sangkomkamhang US, Lumbiganon P, Prasertcharoensook W, Laopaiboon M (2009)Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery, The Cochrane Collaboration, Wiley
RCOG (2011) When your waters break early (preterm prelabour rupture of membranes) – information for you, Royal College of Obstetricians
RCOG (2006) Preterm Prelabour Rupture of Membranes, Green top guideline No 44. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_44.pdf
Rennie JM (2012), Rennie and Robertons Textbook of Neonatology, Fifth edition. Elsevier.Hide details
Shelley's baby Joseph was stillborn at 37 weeks. A post-mortem found that Joseph was suffering from intrauterine growth restriction
Intrauterine growth restriction (IUGR), also known as fetal growth restriction (FGR) is a condition in which a baby's growth slows or stops during pregnancy.
A growing bump is the sign of a growing baby. Your midwife should start measuring your baby from 24 weeks to make sure they are growing well.
ℹLast reviewed on October 4th, 2016. Next review date October 4th, 2019.
By Caroline (not verified) on 28 Mar 2019 - 12:13
I have been draining slowly only at night, I don't know if it is urine or amniotic fluid . Am 27 weeks pregnant. How do I know the difference
By Midwife @Tommys on 15 Apr 2019 - 15:10
For most women, if their waters have broken, they would leak constantly, particularly if they are upright and walking around. However, if you are worried that your waters have gone it is important to seek advice from your midwife or hospital team.
By Boitumelo (not verified) on 19 Mar 2019 - 20:25
Hi I have a pain when am passing urine but this pain also continue even when am not passing urine
By Ghazala (not verified) on 18 Mar 2019 - 15:49
Hi . My waters broke at 18w and am 21w3d now , is there any possibility of creeping infection without any symptoms ??
By Nwando (not verified) on 26 Feb 2019 - 20:20
I usually feel pain when passing urine especially during my ovulation and prior to me seeing my period.the pain comes as am passing the urine but disappears gradually after some time . I have done UTI but nothing was found.pls what can I do
By Midwife @Tommys on 27 Feb 2019 - 12:27
If you have had your urine checked and you do not have a UTI, then please go back to your Doctor. They may need to refer you for a Gynaecology review to make sure that your bladder and kidneys are ok. Please take care, all the best, Tommy's Midwife
By Emma (not verified) on 13 Feb 2019 - 15:12
My waters broke at 26 weeks. I'm currently now 29 weeks I received the essential steroid injections and antibiotics. But for the past few days I've felt feverish but temp hasnt been high :/ and my abdamon is really sore.
By Midwife @Tommys on 15 Feb 2019 - 15:17
I would strongly advise for you to ring the maternity unit to be reviewed if you are feeling feverish and having pain.
By Gia (not verified) on 19 Nov 2018 - 02:49
Hi. My first son was born with an IUGR diagnosis. I see that an uterine infection could have been a cause. My second pregnancy was lost early due to acute deciduitis and now I'm hoping to get pregnant again. Would I need to regularly check for infections during the pregnancy or do anything special ahead of time? Are there intervals at which this should be checked for? I had no symptoms the second pregnancy but did have a tooth infection the first that I wonder if it was the cause.
By Shannon (not verified) on 19 Sep 2018 - 10:13
Hi I wonder if u can help me my baby isn't growing properly . She is 29 weeks formed but is below the growth chart everyone I am measured once at hospItal and once by tape measure she drops.
By Midwife @Tommys on 21 Sep 2018 - 11:17
Hi Shannon, If your baby is below the expected growth, your midwife will refer you for a scan. Measurement by tape measure is only a guide but if the measurement is 3 or more cm below the number of weeks, you will be referred. If you are concerned please talk to your midwife. Best wishes