Chorioamionitis: OB

What percentage of laboring women are thought to be effected by chorio?

10%

How many preterm births are effected by chorio?

30%; cause & consequence of preterm birth

What should be done for women who test positive for Group B streptococcus to prevent chorio and neonatal infection? When do we test for GBS (look up elsewhere)?

36 wks, give antibiotics during labor

Chorio S & S during pregnancy/labor

Maternal fever ≥ 38 C, maternal tachycardia >100 bpm, maternal leukocytosis >15,000, uterine tenderness, purulent/foul-smelling amniotic fluid. fetal tachycarda >160,

Transplacental passage

Passing from other to fetus via placenta

Invasive procedures that increase risk for chorio

artificial rupture of membranes digital cervical exam internal monitoring

what are adverse outcomes of chorio for mother

c-section postpartum hemorrhage infections (endometritis, wound, pelvic abscess, bacteremia) septic shock DIC ARDs death

collaboration needed btwn informatics colleagues & perinatal nurses

create documentation fields that demonstrate value of intrapartum care by nurse & those measures that improve pt outcomes

Chorio development contributing factors

iatrogenic (amniocentesis) transplacental passage ascending infection inflammatory response compromised maternal immune system use of internal monitoring devices amioninfusion prolonged rupture of membrane >12 hrs urogenital infections > 4 vaginal exams in labor obesity genetics periodontal disease lower Genital tract cervicitis UTIs race/ethnicity perineal hygiene

Epidurals

identified as cause of maternal intrapartum fever

Regional Anesthesia

increase risk of chorio because requires immobility & invasive procedures

Elective Induction

increases chorio by increasing likelihood of intro of invasive interventions

Immobility/laying down through labor

increases chorio change due to needing supportive care & invasive procedures

why are broad spectrum antiobiotics given

initiated intrapartum reduce incidence of complications of postpartum for mom & baby give to cover all microbes

Chorioamnionitis "chorio"

intraamniotic infection; inflammation of fetal membranes (amnion &/ chorion) & may extend to umbilical cord

ascending infection

move up from outside body to inside body (up vaginal tract)

Are rates of chorio similar across races/ethnicities

no

Is chorioamnionitis, by itself, an indication for cesarean section?

no

Iatrogenic causes

relating to illness caused by medical examination or treatment

adverse of chorio for neonate

temp instability breathing & feeding problems cerebral palsy pneumonia resp distress death prematurity

why send placenta to pathology

to confirm dx, rule out other factors, higher risk for subsequent pregnancies

under what circumstances should subclinical chorio be suspected?

with premature prolonged rupture of membranes & preterm labor

what contributes to poor perineal hygiene practices

women who labor in bed--> epidurals --> decreased mobility, beed for supportive cares