a) Clinical signs and symptoms
As suggested by the name, clinical chorioamnionitis is diagnosed solely based on clinical signs since access to uncontaminated amniotic fluid or placenta for culture is invasive and usually avoided. Typically, the presence of fever > 100.4 is required in addition to two other signs (uterine tenderness, maternal or fetal tachycardia and foul/purulent amniotic fluid) [2,4,26]. Individual clinical criteria have variable sensitivity and low specificity for chorioamnionitis (see table 2). Because of the low specificity of clinical findings a consideration of other potential sources of fever and other causes of clinical symptoms is essential for the diagnosis of chorioamnionitis [26]. In the absence of other etiologies the combination of 3 clinical criteria provides a highly accurate diagnosis of chorioamnionitis. The presence of risk factors of chorioamnionitis, especially membrane rupture, further strengthens the diagnosis.