Chorioamnionitis
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Outline
Overview
- A bacterial infection of the amniotic cavity
Nursing Points
General
- Causes
- Intrauterine or invasive procedure
- ie: cervical exams
- Amniocentesis
- Prolonged rupture of membranes
- Intrauterine or invasive procedure
- Can result in endometritis and sepsis
Assessment
- Diagnostics
- Fever over 100.4 F + two of the following:
- Leukocytosis
- Tachycardia
- Malodorous amniotic fluid
- Fetal tachycardia
- Fever over 100.4 F + two of the following:
- May have nonspecific signs/symptoms of sepsis that don’t seem like a big deal at first
- Monitor vitals of mom and baby for s/s sepsis or fetal distress
- Maternal tachycardia
- Maternal temperature
- Fetal tachycardia or decelerations
- Draw blood cultures promptly if suspected – BEFORE antibiotics initiated
Therapeutic Management
- Amniocentesis may be indicated for Gram stain / leukocyte count
- If occurring during pregnancy
- If delivery is imminent, obtaining cultures from baby post-delivery is essential and antibiotics will possibly be starting depending on infant’s status
Nursing Concepts
- Reproduction
- Infection control
Patient Education
- Report s/s infection to nurse or provider
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Transcript
I am going to be explaining chorioamnionitis and your role in caring for this patient.
Let’s talk about what is is and why this happens. Chorio is an intrauterine infection. It can be caused by intrauterine procedures so things like cervical exams, placing an internal monitor like a intrauterine pressure monitor or fetal scalp electrode. We are putting something inside that is foreign so it could cause an infection. An amniocentesis could also cause it because we have a needle going into the uterus and amniotic sac and again is foreign to the body. If membranes or the bag of water are broken for a prolonged time it puts the patient more at risk for bacteria to get in. Remember that amniotic sac is there for protection so when it is gone bacteria can easily enter.
To get a diagnosis of chorioamnionitis the patient will have a fever above 100.4 and then 2 additional criteria. The other criteria is leukocytosis so a high white blood cell count. Maternal and fetal tachycardia will also present itself with infection. The last is foul smelling discharge so the bloody show and amniotic fluid that is still leaking out will have a foul odor. These are all main symptoms for diagnosis but they might have some nonspecific symptoms that are unclear and then get worse.
Treatment will include monitoring the vitals of mom and baby for sepsis or fetal distress. So this is getting temperatures, blood pressure and fetal heart rate. The fetal heart rate is usually going to tachycardic but could also have decelerations which are drops in heart rate because of stress to the infection. Blood cultures should be drawn and this must be done before antibiotics are started. Antibiotics can then be given to fight the infections. An amniocentesis might be required if the mother is still pregnant and gets chorioamnionitis. This will be to look at the leukocyte count in the fluid. Of course fetal surveillance will also be done. What does this mean? This is where we get blood cultures on the baby once it is born and possibly start antibiotics on the baby depending on symptoms the baby shows. If the baby isn’t born yet then monitoring of the fetal heart rate will continue.
Reproduction and infection control are our nursing concepts for chorioamnionitis. Reproduction because the patient is pregnant and infection control because we want to prevent chorioamnionitis from occurring and prevent it from getting worse if they have it.
We need the patient to report any signs and symptoms of infection. Temperature, aches/chills, malaise, and any foul discharge should all be reported so patients need to be aware to notify us if these occur so that further examination and treatment can be offered. This will be really important for those that have had an office procedure such as the amniocentesis or chorionic villus sampling so that they know what signs to look for and report from home.
A few key points are that chorioamnionitis is a uterine bacterial infection that needs antibiotics to treat it. The patient will have a high temperature of 100.4 or greater. There will be maternal and or fetal tachycardia or fetal decelerations because of stress. There will be a foul smell coming from the vagina. And last blood cultures are needed to be drawn prior to starting antibiotics.
Make sure you check out the resources attached to this lesson and review those key points. Now, go out and be your best selves today. And, as always, happy nursing.
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