Lesson Objective for Nursing Care Plan on Chorioamnionitis

• Understanding Chorioamnionitis:
  • Gain a comprehensive understanding of chorioamnionitis, including its causes, risk factors, and potential complications during pregnancy and labor.
• Recognition of Clinical Signs:
  • Develop the ability to recognize the clinical signs and symptoms of chorioamnionitis, enabling early identification and prompt intervention to prevent complications.
• Knowledge of Diagnostic Procedures:
  • Familiarize oneself with the diagnostic procedures used to confirm chorioamnionitis, such as laboratory tests and imaging studies, to facilitate timely and accurate diagnosis.
• Collaborative Team Approach:
  • Understand the importance of collaborative teamwork, involving obstetricians, nurses, and other healthcare providers, in managing chorioamnionitis to optimize maternal and fetal outcomes.
• Patient and Family Education:
  • Acquire skills in educating patients and their families about chorioamnionitis, its potential risks, the importance of early intervention, and postpartum care to promote informed decision-making.

Pathophysiology of Chorioamnionitis

• Ascending Infection:
  • Chorioamnionitis commonly results from ascending bacterial infection, where bacteria from the lower genital tract ascend into the amniotic cavity, leading to inflammation.
• Maternal Immune Response:
  • In response to the infection, the maternal immune system releases pro-inflammatory cytokines, triggering an inflammatory response in the fetal membranes (chorion and amnion) and the amniotic fluid.
• Fetal Exposure:
  • The fetus is exposed to the inflammatory process, which can lead to fetal inflammation and activation of the fetal immune response. This exposure poses risks to both the mother and the developing fetus.
• Complications and Preterm Labor:
  • Chorioamnionitis is associated with complications such as preterm labor, premature rupture of membranes, and postpartum endometritis, impacting maternal and neonatal health outcomes.
• Risk Factors:
  • Risk factors for chorioamnionitis include prolonged labor, premature rupture of membranes, multiple vaginal examinations during labor, and certain maternal conditions, emphasizing the importance of early identification and intervention.

Etiology of Chorioamnionitis 

• Bacterial Ascension:
  • Chorioamnionitis is primarily caused by the ascending migration of bacteria from the lower genital tract into the amniotic cavity, with Escherichia coli being a common culprit.
• Prolonged Rupture of Membranes (PROM):
  • Prolonged rupture of membranes, especially when lasting more than 18 hours before delivery, increases the risk of bacterial entry into the amniotic sac, contributing to chorioamnionitis.
• Invasive Procedures:
  • Invasive procedures such as frequent vaginal examinations during labor can introduce bacteria into the reproductive tract, elevating the risk of chorioamnionitis.
• Preexisting Infections:
  • Maternal infections, such as urinary tract infections, can serve as a source for bacteria to ascend and cause chorioamnionitis during pregnancy.
• Immunocompromised States:
  • Conditions that compromise the maternal immune system, such as diabetes or immunosuppressive therapy, may increase susceptibility to chorioamnionitis.

Desired Outcome for Chorioamnionitis Nursing Care 

• Early Identification and Intervention:
  • Achieve early identification of chorioamnionitis signs and symptoms, allowing for prompt initiation of interventions to mitigate potential complications.
• Infection Control and Resolution:
  • Attain resolution of the infection through effective antimicrobial therapy, reducing maternal and fetal risks associated with untreated chorioamnionitis.
• Prevention of Preterm Birth:
  • Minimize the risk of preterm birth by managing chorioamnionitis promptly, preventing complications associated with preterm labor and delivery.
• Maternal Well-being:
  • Ensure the well-being of the mother by preventing the spread of infection, reducing the risk of postpartum complications, and promoting a healthy recovery.
• Neonatal Health:
  • Promote optimal neonatal outcomes by preventing intrauterine infection, reducing the risk of sepsis, and addressing any potential complications associated with chorioamnionitis.

Chorioamnionitis Nursing Care Plan

Nursing Assessment for Chorioamnionitis 

• Maternal Vital Signs:
  • Monitor maternal vital signs, including temperature, heart rate, and blood pressure, frequently for signs of systemic infection such as fever (usually > 100.4°F or 38°C).
• Uterine Tenderness and Contractions:
  • Assess for uterine tenderness and monitor the frequency, duration, and intensity of contractions to identify changes indicative of chorioamnionitis.
• Fetal Heart Rate Monitoring:
  • Continuously monitor fetal heart rate patterns for signs of distress or changes, as chorioamnionitis can impact fetal well-being.
• Observation for Vaginal Discharge:
  • Evaluate the color, consistency, and odor of vaginal discharge for any signs of infection, such as foul smell or purulent discharge.
• Laboratory Investigations:
  • Order and review laboratory tests, including complete blood count (CBC) and C-reactive protein (CRP), to assess for elevated white blood cell count and inflammatory markers.
• Amniotic Fluid Analysis:
  • If possible, analyze amniotic fluid for signs of infection, including an elevated white blood cell count or positive cultures.
• Maternal Symptom Assessment:
  • Assess maternal symptoms, such as malaise, fatigue, and anorexia, as these can be indicative of a systemic response to infection.
• Patient History:
  • Obtain a detailed patient history, including any risk factors such as prolonged rupture of membranes, recent invasive procedures, or preexisting infections.

Implementation for Chorioamnionitis

• Administer Antibiotics:
  • Administer broad-spectrum antibiotics as prescribed by the healthcare provider to target the infection. Ensure that the woman receives the full course of antibiotics to effectively eliminate the causative organisms.
• Monitor Vital Signs:
  • Continuously monitor the woman’s vital signs, including temperature, heart rate, and blood pressure. Frequent monitoring is crucial to identify any signs of worsening infection or sepsis promptly.
• Fetal Monitoring:
  • Implement continuous fetal monitoring to assess the well-being of the baby. This includes monitoring fetal heart rate patterns and uterine contractions. Any signs of fetal distress should be promptly addressed.
• Intravenous (IV) Fluids:
  • Administer intravenous fluids to maintain hydration and support the woman’s cardiovascular system. Adequate hydration is essential for maternal well-being and can help prevent complications.
• Pain Management:
  • Provide pain management interventions, such as analgesics or antipyretics, as prescribed to alleviate discomfort associated with chorioamnionitis. Ensure that pain relief measures are safe for both the mother and the baby.
• Induction or Acceleration of Labor:
  • If necessary, implement interventions to induce or accelerate labor to reduce the duration of exposure to the infection. This may involve the use of oxytocin or other labor-inducing medications.
• Continuous Assessment:
  • Conduct regular assessments of the woman’s overall condition, including uterine contractions, cervical dilation, and any signs of infection. This ongoing assessment guides the adjustment of interventions based on the woman’s response to treatment.
• Educate the Pregnant Patient:
  • Provide education to the pregnant person about the importance of completing the prescribed antibiotics, signs and symptoms to monitor at home, and the need for follow-up care. Ensure they understand the potential risks and benefits of interventions.
• Temperature Management:
  • Implement measures to manage maternal fever, such as antipyretic medications and cooling measures, to prevent complications associated with hyperthermia.
• Collaborate with Obstetric Team:
  • Collaborate closely with obstetricians and other healthcare providers to coordinate the management of chorioamnionitis, ensuring a multidisciplinary approach to care.

Nursing Interventions and Rationales

Evaluation for Chorioamnionitis Nursing Care 

• Resolution of Symptoms:
  • Evaluate the resolution of maternal symptoms such as fever, uterine tenderness, and malaise to determine the effectiveness of the antibiotic therapy.
• Stability of Vital Signs:
  • Monitor maternal vital signs for stability, ensuring that temperature, heart rate, and blood pressure remain within normal ranges.
• Improvement in Laboratory Markers:
  • Assess changes in laboratory markers, such as a decreasing white blood cell count and normalization of C-reactive protein levels, indicating a positive response to treatment.
• Fetal Well-being:
  • Evaluate the stability or improvement of fetal well-being through ongoing monitoring of fetal heart rate patterns and any signs of distress.
• Adherence to Treatment Plan:
  • Ensure the patient’s adherence to the prescribed treatment plan and medications, providing education and support as needed for continued recovery.

References

https://my.clevelandclinic.org/health/diseases/12309-chorioamnionitis

https://www.stanfordchildrens.org/en/topic/default?id=chorioamnionitis-90-P02441