Chorioamnionitis

What is chorioamnionitis?

- infection of uterus The amniotic fluid, placenta, and baby can all become infected. - can occur with normal and dysfunctional labors - with any pregnant woman anytime during labor after rupture of membranes.

How are you going to reduce the risk of infection?

- wash hands, gloves - limit vag contact - only essential exams -reduce possibly transmitting organisms into vag cavity - aseptic technique - keep under pads dry- bacteria likes warm moist environment - clean excessive secretions as needed from vag area- front to back - prophylactic antiobiotics to prevent neonatal sepsis

Maternal temperature: when to assess w/ normal labor? " " after ROM? " " is elevated or other SOI present?

-assess every 2 to 4 hours in normal labor - every 2 hours after membranes rupture; - assess hourly if elevated (≥100.4° F) or if other signs of infection are present.

Preparation for home management includes teaching: *5

1.) Avoid sex or inserting anything into the vagina. 2.) Avoid breast stimulation if the gestation is preterm because it can cause release of oxytocin. 3.) Monitor the temperature at least four times a day, reporting any temperature greater than 100° F. 4.) Maintain any activity restrictions. 5.) Note and report uterine contractions or vaginal drainage with a foul odor.

Chorioamnionitis symptoms *6

1.) maternal fever > 100.4 F 2.) uterine tenderness- can be abdominal tenderness, but not all mothers develop symptoms. 3.) vaginal discharge- green/yellow w/ foul odor 4.) maternal WBC > 11,000 5.) Maternal tachycardia 6.) FHR: persistent fetal tachycardia > 160 bpm for more than 10 minutes A laboring woman with prolonged ROM remains at higher risk for infection and should continue to be observed for signs and symptoms of infection.

Infants of mothers who have ROM longer than _____ have an increased risk of infection.

18 hours

risk for infection during who when

Both mother and newborn are at risk for infection during the intrapartum and postpartum periods.

Assess the fetal heart rate (FHR) and maternal vital signs for manifestations of infection: *2

FHR: persistent fetal tachycardia (more than 160 beats per minute [bpm] for more than 10 minutes) is often an early sign of intrauterine infection and often occurs with maternal fever.

Assess maternal (3) hourly to identify what (2)

Maternal pulse, respirations, and blood pressure: - assess at least hourly to identify tachycardia or tachypnea, which often accompany temperature elevation.

Chorioamnionitis can develop as a result of prolonged:

Preterm premature rupture of membranes (PPROM) Spontaneous rupture of membranes (SROM) Artificial rupture of membranes (AROM) Ruptured membranes removes the barrier and vaginal organisms have access to the uterine cavity and may cause chorioamnionitis. - risk is low at first- increases as time btwn membrane rupture and delivery goes on. Birth within 24 hours of ROM (amniotomy) is desirable.

If the infection is not immediately caught, the infant's side-effects could include: *3

Sepsis (a dangerous infection in the blood) Meningitis (an infection in the lining of the spinal cord) Severe respiratory problems.

Symptoms of infant w/ Chorioamnitis - think all body systems affected

Weak cries, poor sucking, and fatigue Temperature problems: hypothermia or hyperthermia Cardiovascular problems: cyanosis, pallor, tachycardia, and hypotension Pulmonary problems: retractions, tachypnea, grunting, and apnea Gastrointestinal problems: poor feeding, vomiting, diarrhea, and abd. distention CNS problems: decreased muscle tone, lethargy, high-pitched cry

Abnormal amniotic/ vaginal fluid

Yellow or cloudy fluid or fluid with a foul or strong odor suggests infection, and vernix may be stained by discolored fluid.The strong odor may be noted before birth or afterward on the infant's skin.

If there is any evidence of chorioamnionitis along with the PROM

a sepsis work-up must be initiated and the baby begun on intravenous antibiotics as soon as possible.

If the infant is symptomatic

a sepsis work-up will be performed. The newborn may be transferred to the NICU or SCU after delivery for prompt treatment. The attending neonatologist should be consulted regarding duration of therapy in all cases.

Medications used to treat chorioamnionitis during and after delivery: *6

ampicillin (PO/IV) gentamicin (IV) penicillin (PO) clindamycin (PO or IV) metronidazole (PO/IV) vancomycin (PO/IV)

if chorioamnionitis is suspected, treat the infant with

at least 48 hrs of antibiotics depending on labs, and cultures.

The length of antibiotic therapy should be based on the *4

clinical course, lab results, cultures as well as the suspected etiology of maternal fever.

Normal amniotic/vaginal fluid

normal clear color and mild odor. Small flecks of white vernix are normal.

If the infant is asymptomatic *2

observation for 48 hours in the hospital Obtain a CBC with differential at birth and at a minimum of 6- 12 hrs. of life.

interventions

promote maternal rest to promote healing & reduce fetal distress prep for delivery if advanced infection present check urinalysis for bacteria even if pt asymptomatic - monitor maternal vitals monitor FHR check WBC count

If signs of infection are noticed

report them to the birth attendant for treatment. Know time membranes ruptured to identify prolonged ROM Antibiotics will be ordered and started. Maintain closer monitoring of both laboring mother and fetus. When delivery is ready to occur the neonatal team will be consulted for delivery.

The current recommendation to treat or prevent PPROM/SROM/AROM-associated infections is

the administration of IV antibiotics for 48 hours, followed by 5 days of oral antibiotics.

If a sepsis work-up has been performed,

the infant should be reassessed at 48 hours. Antibiotics, lab work, oxygen, whatever is needed to stabilize the newborn.

the infant will usually not have any long-term effects to chorioamnionitis if

the infection is caught immediately and given antibiotics

If the blood culture is positive

treat for a minimum of 10 days.

If the CSF culture is positive

treat for a minimum of 14-21 days.

Assessments to monitor for possible infection: *3

woman's temperature & vitals amniotic/vag fluid fetal activity- external fetal monitor tracing should have a reassuring pattern uterine contractions/tenderness