Nursing Care Plan for Chorioamnionitis

Pathophysiology

Chorioamnionitis is a bacterial infection of the membranes (amnion and chorion) and amniotic fluid surrounding a fetus within the uterus. This condition is common in births where membranes rupture prematurely. It is, however, much more uncommon (up to 2% in the United States) in full-term births, and typically occurs in the later stages of pregnancy. The infection typically starts in the vagina, anus or rectum of the mother and moves up into the uterus.

Etiology

When the membranes rupture and a long labor ensues, this leaves the vaginal canal open to the uterus and allows opportunity for bacteria (commonly Group B Streptococcus, GBS) to travel from the vagina into the uterus. It can lead to further complications such as blood clots in the pelvis and lungs of the mother and infections such as pneumonia of the fetus.  Risk factors include compromised maternal immune system, obesity, use of internal monitoring devices and multiple (more than 4) vaginal exams during labor.

Desired Outcome

Patient (mother and fetus) will be free from infection, prevention of complications or fetal infection

Chorioamnionitis Nursing Care Plan

Subjective Data:

  • Abdominal (uterine) tenderness

Objective Data:

  • Fever
  • Vaginal discharge
  • Tachycardia
  • Diaphoresis

Nursing Interventions and Rationales

  1. Monitor maternal vital signs for fever or tachycardia that may indicate infection

  2. Symptoms are similar to other diseases and must be monitored closely to prevent development of complications

  3. Monitor fetal heart rate

  4. Elevated fetal heart rate indicates a sign of distress. If the fetal heart rate increases, assess the mother for signs of infection.

  5. Monitor diagnostic test results including white blood cell count and urinalysis

    • Patient may be asymptomatic, but have bacteria in the urine.
    • An elevated white count may indicate infection, but is also a common occurrence during labor and delivery.
    • Also, monitor for effectiveness of medication (i.e. antipyretics and antibiotics)

  6. Assess and culture vaginal discharge, if present

    • Some STDs and GBS may be the bacterial cause of chorioamnionitis.
    • Note color, odor and consistency of any discharge and culture to determine the appropriate course of treatment.

  7. Verify allergies and administer medications as necessary

    • Depending on cause of infection, antibiotics may include penicillin or erythromycin;
    • Antipyretics may be given for fever, such as acetaminophen;
    • If patient is in labor, administer medications via IV route if appropriate.
    • Assess for allergies prior to administering medications.

  8. Prepare patient for vaginal or c-section delivery if indicated

  9. Advanced infection may require early termination of pregnancy. Depending on gestational age, patient may have induced labor or c-section delivery to prevent complications and fetal infection.

  10. Promote rest

  11. Encourage patient to rest as much as possible to promote healing and reduce fetal distress

  12. Provide patient education for prevention of further infection

  13. If membranes have ruptured, avoid tub or sitz bath to reduce bacterial exposure to the vagina and uterus.


References

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