O41.122 Chorioamnionitis, second trimester

Name of the Condition

• Chorioamnionitis, Second Trimester (ICD Code: O41.122)

Summary

Chorioamnionitis is an infection of the fetal membranes (chorion and amnion) and amniotic fluid during pregnancy. This condition involves microbial invasion, typically bacterial, and can affect both maternal and fetal health. It is often associated with inflammation and may lead to complications if not managed promptly. The infection can occur at any stage of pregnancy but is more common in the second or third trimester.

Causes

The infection usually results from bacteria ascending from the vaginal tract into the uterus, though hematogenous spread (via the bloodstream) or direct contamination can also occur. Common pathogens include group B streptococcus, Escherichia coli, and other vaginal flora. Risk increases with prolonged rupture of membranes or invasive procedures during pregnancy.

Risk Factors

• Prolonged rupture of membranes (especially >18 hours)
• Multiple vaginal examinations during labor
• Preterm labor or delivery
• Maternal infections (e.g., urinary tract infections)
• Low socioeconomic status or limited prenatal care
• History of prior intrauterine infections

Symptoms

• Maternal fever (≥38°C or 100.4°F)
• Maternal tachycardia (≥100 beats per minute)
• Fetal tachycardia (≥160 beats per minute)
• Uterine tenderness
• Foul-smelling amniotic fluid (if membranes are ruptured)

Diagnosis

Diagnosis relies on clinical evaluation of maternal symptoms, laboratory testing for infection markers (e.g., elevated white blood cell count), and ultrasound to assess amniotic fluid and fetal status. Amniocentesis may be used for culture if membranes are ruptured.

Treatment Options

Treatment typically involves intravenous antibiotics to target common pathogens. Delivery may be expedited if the infection is severe or if the fetus is at risk. Supportive care, such as hydration and monitoring, is also provided. The choice of antibiotics depends on local resistance patterns and maternal-fetal considerations.

Prognosis and Follow-Up

With prompt treatment, outcomes can improve, but complications may still occur. Follow-up care includes monitoring for maternal recovery and fetal well-being. Long-term effects on the infant, such as sepsis or respiratory issues, may require additional evaluation.

Complications

• Maternal sepsis or endometritis
• Preterm birth
• Fetal infection or sepsis
• Neonatal respiratory distress
• Increased risk of cesarean delivery

Lifestyle & Prevention

• Attend regular prenatal care to detect and manage infections early.
• Avoid unnecessary vaginal examinations during pregnancy.
• Report any signs of infection (e.g., fever, unusual discharge) promptly.
• Follow guidelines for membrane rupture management to reduce infection risk.

When to Seek Professional Help

Seek immediate medical attention if experiencing fever, uterine tenderness, foul-smelling vaginal discharge, or fetal movement changes. These symptoms may indicate chorioamnionitis or other serious conditions requiring urgent evaluation.

Tips for Medical Coders

Document the trimester (second trimester) and any relevant clinical details to support the use of O41.122. Ensure documentation aligns with the specific timing of the infection and any associated complications. Verify that the code is used only when the condition is confirmed during the second trimester of pregnancy.