Chorioamnionitis

Chorioamnionitis Nursing Care Plans Diagnosis and Interventions

Chorioamnionitis NCLEX Review Care Plans

Nursing Study Guide on Chorioamnionitis

Chorioamnionitis is a pregnancy-related condition that refers to the bacterial infection of the surrounding membranes of the fetus.

The infection can occur in the amniotic fluid and placenta, specifically in the chorion, the outermost layer of the placenta, and the amnion which is the innermost layer.  This condition is also known as amnionitis and intra-amniotic infection.

Chorioamnionitis can occur before or during labor and is commonly seen in pre-term births. It is often caused by ascending or retrograde infection from more than one opportunistic bacterium present in the genital organs.

Signs and Symptoms of Chorioamnionitis

Chorioamnionitis does not always manifest in affected women. If present, the clinical signs and symptoms may include the following:

  • Fever – hyperthermia is an important symptom in the diagnosis of chorioamnionitis; occurs in 95 to 100% of cases
  • Tachycardia of the mother
  • Fetal or newborn tachycardia
  • Uterine tenderness
  • Foul-smelling or discolored amniotic fluid

Causes of Chorioamnionitis

Chorioamnionitis is an infection caused by the natural flora present in the mother’s vagina. The opportunistic bacteria can climb up to the uterus due to several mechanisms including an early rupture of the bag of water.

The risk factors for the development of chorioamnionitis are the following:

  • Premature rupture of the bag of water or amniotic sac
  • Prolonged labor
  • Frequent vaginal examination during labor
  • First pregnancy
  • Presence of sexually transmitted infection or other vaginal infections
  • Alcohol or tobacco use
  • Undergoing an internal fetal monitoring
  • Having an epidural anesthesia
  • Having an ongoing group b strep infection

Complications of Chorioamnionitis

Chorioamnionitis is a rare condition. When it occurs, it is often regarded as a medical emergency due to the possible serious effects it has on both the mother and the fetus or baby. The known complications of chorioamnionitis are the following:

  1. Bacteremia. Chorioamnionitis can lead to a serious blood infection to the mother called bacteremia. This can cause preterm delivery and can lead to secondary infections to the newborn baby such as pneumonia and meningitis. It can also result in brain damage and even death to the newborn.
  2. Endometritis. The infection from chorioamnionitis can spread into the uterus causing endometritis.
  3. The need for cesarean delivery. A cesarean delivery (C-section) may be the preferred method of delivery in case of chorioamnionitis for the safety of the mother and the baby.
  4. Heavy blood loss during delivery
  5. Blood clot formation. Blood clots can occur particularly affecting the pelvis and the lungs.
  6. Babies born from mothers with chorioamnionitis are at risk of developing meningitis and pneumonia.
    1. Meningitis – this refers to the infection of the brain and/or spinal cord. It occurs in less than 1% of full-term infants from mothers with chorioamnionitis
    1. Pneumonia and bacteremia – pneumonia and bacteremia are more common with an incidence rate of 5-10% of cases.

Diagnosis of Chorioamnionitis

  • Clinical signs and symptoms – chorioamnionitis’ diagnosis is commonly made through the presence of its clinical manifestations. Fever occurs in 95-100% of cases hence it is almost always required to come up with the diagnosis. The use of clinical signs and symptoms is often preferred to avoid the use of more invasive procedures for the diagnosis.
  • Laboratory tests – lab tests are often helpful in confirming a diagnosis when the clinical manifestations are inconclusive in the diagnosis of chorioamnionitis.
    • Maternal CBC – a complete blood count with a focus on the white blood cell count can signify the presence of infection.
    • Other blood tests – high levels of C-reactive protein, lipopolysaccharide-binding protein (LBP), soluble intercellular adhesion molecule I (sICAM 1), and interleukin 6 are associated with chorioamnionitis. However, their use for the diagnosis of this condition is not fully established yet.
    • Amniocentesis – this is an invasive procedure involving the insertion of a needle into the amniotic sac to aspirate samples of the amniotic fluid. Low levels of glucose and high concentrations of WBC and bacteria in the sample are indicative of chorioamnionitis.
    • Placental and umbilical cord pathology – a tissue sample from the maternal placenta and newborn’s umbilical cord can be set for lab testing. Histologic changes will be noted in positive cases of chorioamnionitis.
  • Differential diagnosis – other conditions that can possibly cause the signs and symptoms reported must be ruled out by the medical team.

Treatment for Chorioamnionitis

Early treatment for chorioamnionitis is not only beneficial to the pregnant mother but also the unborn or newly born baby as well. Treatment involves the intake of antibiotics which can be prescribed for use even after delivery.

  1. Antibiotics. The use of a broad-spectrum antibiotic is proven to improve the outcome of pregnancies in women with chorioamnionitis.
  2. Supportive measures. Interventions to address the clinical manifestations are effective in providing comfort to a mother with chorioamnionitis and her newborn. Interventions will be different per case depending on the severity of effect the condition has on the mother and the baby.

Nursing Care Plans for Chorioamnionitis

Nursing Care Plan 1

Nursing Diagnosis: Infection related to chorioamnionitis as evidenced by temperature of 38.7 degrees Celsius, tachycardia (maternal/ and or fetal), myalgia, and fatigue

Desired Outcome: The patient will be able to receive appropriate treatment for the infection.

InterventionRationale
Assess vital signs and monitor the signs of infection.To establish baseline observations and check the progress of the infection as the patient receives medical treatment.
Inform the patient about amniocentesis.Amniocentesis is an invasive procedure involving the insertion of a needle into the amniotic sac to aspirate samples of the amniotic fluid. Low levels of glucose and high concentrations of WBC and bacteria in the sample are indicative of chorioamnionitis.
Administer the prescribed antibiotics.To treat chorioamnionitis.
Monitor vital signs closely.To check the progress of the patient under antibiotic treatment.  
Provide symptomatic relief for the patient.The patient may require treatment based on their symptoms, such as antipyretics for fever.
Explain to the mother that C-section may be performed.A cesarean delivery (C-section) may be the preferred method of delivery in case of chorioamnionitis for the safety of the mother and the baby.

Nursing Care Plan 3

 Nursing Diagnosis: Hyperthermia related to chorioamnionitis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionRationale
Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic for the treatment of chorioamnionitis. Use the anti-pyretic medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 3

Nursing Diagnosis: Risk for Maternal Bleeding related to chorioamnionitis

      Desired Outcome: To prevent or treat heavy blood loss during delivery.

InterventionsRationales
Assess the patient’s vital signs and perform a focused physical assessment, looking for any signs of bleeding.Chorioamnionitis increases the risk for bleeding during delivery. Low blood pressure, low temperature, and dizziness may result from excessive bleeding.
Obtain Group and Save blood samples from the patient. Anticipate the need for the patient to have a transfusion whole blood replacements.To prepare for any need to perform blood transfusion as prescribed. If the blood loss is too much and immediate correction is warranted, whole blood transfusion is administered.
Perform the blood transfusion if indicated.Blood transfusion may be required if there is too much blood loss.
Post-surgery, assess and monitor the patient’s surgical wound site for any signs of unexpected bleeding.To treat any unexpected bleeding as early as possible.

Nursing Care Plan 4

Nursing Diagnosis: Risk for Deficient Fluid Volume

Desired Outcome: The patient will maintain a functional body fluid volume and a balanced input and output status.

InterventionRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Headaches, low blood pressure, and pain are associated with the mother’s blood loss.
Start input and output monitoring.To monitor circulatory blood volume. To ensure that the mother has adequate oral hydration or if there is a need to commence IV hydration therapy.
Consider hospitalization for serious maternal hemorrhage.To closely monitor the symptoms of chorioamnionitis and deficient fluid volume in the appropriate setting.
Prepare the patient for C-section related to maternal bleeding.For heavy bleeding, immediate C-section is strongly recommended. Corrective surgery to control the bleeding will also be done and may involve some surgical techniques as appropriate.
  Refer the patient to a dietitian for proper monitoring and advice of salt, caloric and protein intake.Consuming salt between 2 to 4 g per day is ideal as very low salt intake may increase dehydration, while high salt intake may cause edema formation.

Other possible nursing diagnoses:

  • Risk for Maternal/Fetal Injury
  • Fatigue
  • Fear/ Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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