Chorioamnionitis is a serious infection of the fetal membranes (chorion and amnion) and amniotic fluid that occurs during pregnancy. This nursing diagnosis focuses on identifying and treating the infection, preventing complications, and ensuring the safety of both mother and fetus.
Causes (Related to)
Chorioamnionitis can develop due to various factors that increase infection risk:
- Prolonged rupture of membranes (>18 hours)
- Multiple vaginal examinations during labor
- Internal fetal monitoring
- Presence of Group B Streptococcus
- Bacterial vaginosis
- Maternal risk factors including:
- Young maternal age
- Nulliparity
- Long labor duration
- Epidural anesthesia
- Pregnancy-related factors including:
- Preterm labor
- Cervical insufficiency
- Presence of intrauterine devices
Signs and Symptoms (As evidenced by)
Chorioamnionitis presents with distinctive clinical manifestations that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Uterine tenderness
- Foul-smelling vaginal discharge
- General malaise
- Chills
- Abdominal pain
- Contractions
Objective: (Nurse assesses)
- Maternal fever (>100.4°F/38°C)
- Maternal tachycardia (>100 bpm)
- Fetal tachycardia (>160 bpm)
- Purulent amniotic fluid
- Elevated white blood cell count
- Uterine tenderness
- Elevated C-reactive protein
Expected Outcomes
The following outcomes indicate successful management of chorioamnionitis:
- Maternal temperature will return to the normal range
- Fetal heart rate will stabilize
- Infection will be controlled
- No complications will develop
- Mother will demonstrate an understanding of post-delivery care
- Successful delivery of the infant
- Prevention of postpartum complications
Nursing Assessment
Monitor Vital Signs
- Check maternal temperature q2-4h
- Monitor maternal heart rate
- Track fetal heart rate continuously
- Assess blood pressure
- Monitor respiratory rate
Evaluate Labor Progress
- Monitor contraction pattern
- Assess cervical dilation
- Document membrane status
- Track labor duration
Assess Infection Status
- Monitor laboratory values
- Check wound sites
- Assess vaginal discharge
- Document antibiotic administration
- Monitor for sepsis signs
Monitor Fetal Well-being
- Continuous fetal monitoring
- Track fetal movement
- Assess amniotic fluid
- Document fetal response
Evaluate Maternal Comfort
- Assess pain levels
- Monitor comfort measures
- Document coping strategies
- Evaluate emotional status
Nursing Care Plans
Nursing Care Plan 1: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to intrauterine infection as evidenced by maternal temperature >100.4°F and maternal tachycardia.
Related Factors:
- Inflammatory response
- Bacterial infection
- Increased metabolic rate
- Immune system response
Nursing Interventions and Rationales:
- Monitor temperature q2h
Rationale: Tracks fever progression and response to antibiotics - Administer antipyretics as ordered
Rationale: Reduces maternal fever and associated discomfort - Apply cooling measures
Rationale: Assists in temperature reduction - Monitor fetal response to maternal fever
Rationale: Identifies fetal distress early
Desired Outcomes:
- Maternal temperature will return to normal range within 24 hours
- Fetal heart rate will stabilize
- The patient will report improved comfort
Nursing Care Plan 2: Risk for Maternal/Fetal Infection
Nursing Diagnosis Statement:
Risk for Progressive Infection related to chorioamnionitis as evidenced by elevated white blood cell count and maternal fever.
Related Factors:
- Presence of pathogenic organisms
- Compromised protective barriers
- Prolonged rupture of membranes
- Multiple vaginal examinations
Nursing Interventions and Rationales:
- Administer prescribed antibiotics
Rationale: Treats underlying infection - Monitor infection markers
Rationale: Tracks treatment effectiveness - Implement infection control measures
Rationale: Prevents spread of infection
Desired Outcomes:
- Infection markers will improve
- No additional complications will develop
- Mother and fetus will show no signs of sepsis
Nursing Care Plan 3: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to the inflammatory process and uterine contractions as evidenced by verbal reports of pain and guarding behavior.
Related Factors:
- Inflammatory process
- Uterine contractions
- Tissue inflammation
- Labor progression
Nursing Interventions and Rationales:
- Assess pain characteristics
Rationale: Guides pain management strategies - Administer prescribed pain medication
Rationale: Promotes comfort and reduces stress - Provide non-pharmacological comfort measures
Rationale: Enhances pain management effectiveness
Desired Outcomes:
- The patient will report adequate pain control
- The patient will demonstrate effective coping strategies
- The patient will maintain stable vital signs
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to maternal and fetal health concerns, as evidenced by expressed worry and increased tension.
Related Factors:
- Threat to maternal health
- Concern for fetal well-being
- Uncertainty about outcome
- Change in health status
Nursing Interventions and Rationales:
- Provide clear information
Rationale: Reduces fear of the unknown - Maintain calm environment
Rationale: Promotes relaxation - Include a support person in care
Rationale: Enhances emotional support
Desired Outcomes:
- The patient will verbalize decreased anxiety
- The patient will demonstrate improved coping
- The patient will participate in decision-making
Nursing Care Plan 5: Risk for Impaired Gas Exchange (Fetal)
Nursing Diagnosis Statement:
Risk for Impaired Fetal Gas Exchange related to maternal infection as evidenced by changes in fetal heart rate patterns.
Related Factors:
- Placental inflammation
- Maternal fever
- Compromised uteroplacental blood flow
- Fetal stress response
Nursing Interventions and Rationales:
- Monitor fetal heart rate continuously
Rationale: Detects early signs of distress - Position mother optimally
Rationale: Improves uteroplacental perfusion - Administer oxygen as ordered
Rationale: Enhances fetal oxygenation
Desired Outcomes:
- Fetal heart rate will remain within normal limits
- Fetal movement will remain reassuring
- Adequate oxygenation will be maintained
References
- Gantert M, Been JV, Gavilanes AW, Garnier Y, Zimmermann LJ, Kramer BW. Chorioamnionitis: a multiorgan disease of the fetus? J Perinatol. 2010 Oct;30 Suppl:S21-30. doi: 10.1038/jp.2010.96. PMID: 20877404.
- Jain VG, Willis KA, Jobe A, Ambalavanan N. Chorioamnionitis and neonatal outcomes. Pediatr Res. 2022 Jan;91(2):289-296. doi: 10.1038/s41390-021-01633-0. Epub 2021 Jul 1. PMID: 34211129; PMCID: PMC8720117.
- Peng CC, Chang JH, Lin HY, Cheng PJ, Su BH. Intrauterine inflammation, infection, or both (Triple I): A new concept for chorioamnionitis. Pediatr Neonatol. 2018 Jun;59(3):231-237. doi: 10.1016/j.pedneo.2017.09.001. Epub 2017 Sep 19. PMID: 29066072.
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Stuijt, D., Bos, M., Nikkels, P., Wolterbeek, R., & Van der Meeren, L. (2024). Significant association between circumvallate placenta, placental abruption and acute chorioamnionitis in preterm birth: A 23-year retrospective cohort study. Placenta, 146, 25-29. https://doi.org/10.1016/j.placenta.2023.12.018
