ABSTRACT
Preterm labor, cervical cerclage (especially when performed as an emergency procedure),
and diabetes mellitus are all associated with an increased risk of chorioamnionitis.
It might be expected that the combination of all 3 could lead to especially severe
infection. We report such a case. A woman with a history of two spontaneous midtrimester
abortions had had cervical cerclage performed at 13 weeks. She was referred at 24
weeks' gestation with preterm labor, and the cervix was found to be dilated. An emergency
repeat cerclage was performed. The following day, ultrasonography revealed the presence
of intra-amniotic gas. Infection was confirmed by the presence of a purulent cervical
discharge, a neutrophilia with a left shift, and an elevated C-reactive protein level.
The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed
to the complications of prematurity and sepsis. E. coli was isolated. In her subsequent pregnancy, severe gestational diabetes was diagnosed
and following pregnancy, permanent diabetes mellitus was confirmed. The combination
of infection, diabetes, and intact membranes may lead to a particularly severe form
of chorioamnionitis, with the production of gas within the amniotic cavity. Infection
should be excluded before emergency cervical cerclage, especially in the woman with
diabetes mellitus.
Keywords
Chorioamnionitis - cervical cerclage - diabetes.
