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Infections during pregnancy and fetal inflammatory response syndrome (FIRS)

With proper prenatal care, infections may be treated before FIRS

Fetal inflammatory response syndrome (FIRS) is a dangerous medical condition that can affect pre-term babies. It’s caused by an out-of-control inflammatory cascade throughout the body in response to a bacterial, viral, fungal, or protozoan infection.

The standard of care requires obstetricians (OB/GYNs) providing prenatal care to be diligent in recognizing signs and symptoms of infections during pregnancy. Prompt diagnosis and treatment may prevent complications, including FIRS.

Diagnosis of FIRS

Medical researchers first identified FIRS as being similar to an adult condition called systemic inflammatory response syndrome (SIRS). Many experts believe that FIRS should be considered when there’s preterm labor with or without the rupture of membranes (bag of water ruptures) and the possibility of an infection.

The sequence of events starts with an intra-amniotic (tissues around the fetus) infection, causing maternal or fetal secretion of pro-inflammatory cytokines, which triggers pre-term labor.

Physicians diagnose FIRS by looking for higher than normal levels of umbilical cord plasma or increased values of C-reactive protein or cytokines, such as interleukin-6 (IL-6) in the umbilical cord blood. Pathologists look for funisitis (inflammation of the connective tissue of the umbilical cord) or chorionic vasculitis (inflammation of the umbilical vessels) in the umbilical cord, which are also classic signs of FIRS.

Adverse effects of FIRS

Babies born with FIRS have a higher risk for a number of problems, including:

• Sepsis (a dangerous systemic inflammatory response to an infection)

• Intraventricular hemorrhage (brain bleed)

• Periventricular leukomalacia (damage to the brain’s white matter, which can cause cerebral palsy)

• Chronic lung disease

• Death

Medical treatment and management of FIRS

Current research recommends that obstetricians try to identify the causes of fetal systemic inflammation before birth, which may require emetic fluid collecting amniotic fluid samples. Further, the medical team should consider antibiotic therapy because it has been shown to eradicate intra-amniotic inflammation and infection, which can reduce the rate of FIRS.

When the diagnosis of FIRS is established, the standard of care requires the medical team, including an obstetrician or consulting maternal fetal medicine physician, to balance the risks versus benefits of preterm delivery. Rapid delivery provides a benefit to the baby of exiting the hostile environment caused by infection and FIRS. Yet, preterm delivery poses its own risks of complications.

Experts recommend consideration of medications including antibiotics to treat infection and immunomodulatory drugs, such as dexamethasone and indomethacin, which suppress local inflammatory responses. These may work to prolong gestation (pregnancy) in cases of FIRS and pre-term labor.

If your pregnancy or child has been impacted from FIRS, then contact a top rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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