Chorioamnionitis
Key Points
- Chorioamnionitis is infection of the amnion and chorion that surround the fetus.
- Infection usually ascends from vaginal/cervical flora and is commonly associated with group B streptococcal pathways.
- Major risk factors include prolonged labor, prolonged/premature rupture of membranes, multiple vaginal exams, internal fetal monitors, meconium-stained fluid, and genital-tract bacterial burden.
- Core diagnostic cues include maternal/newborn fever (38 C or higher), maternal or fetal tachycardia, uterine tenderness, foul-smelling amniotic fluid, and purulent cervical discharge.
- Maternal complications include dysfunctional labor, uterine atony with hemorrhage risk, endometritis, and sepsis.
- Neonatal complications include pneumonia, meningitis, and sepsis; early treatment is critical for maternal-neonatal outcomes.
Pathophysiology
Chorioamnionitis develops when microorganisms ascend into the amniotic cavity and infect fetal membranes. Inflammatory response within the intrauterine environment can rapidly involve maternal tissues, placenta, and fetus/newborn.
This process increases risk of uterine dysfunction, hemorrhage, and systemic infection in the birthing patient, while exposing the fetus/newborn to invasive infectious morbidity.
Classification
- Antepartum/intrapartum intraamniotic infection: Membrane infection identified before or during labor.
- Maternal-complication pathway: Dysfunctional labor, postpartum uterine atony/hemorrhage, endometritis, and sepsis progression.
- Neonatal-complication pathway: Pneumonia, meningitis, and neonatal sepsis.
Nursing Assessment
NCLEX Focus
In suspected chorioamnionitis, maternal-fetal trend surveillance and early escalation are priority over isolated single findings.
- Assess temperature trend and treat fever at or above 38 C (100.4 F) as significant in this context.
- Monitor maternal and fetal heart rates for tachycardia.
- Assess uterine tenderness, amniotic-fluid odor, and cervical-discharge characteristics.
- Assess rupture-of-membrane duration, labor duration, and number of vaginal exams.
- Monitor for early maternal sepsis progression (mental-status change, hypotension, low urine output, worsening perfusion).
- Coordinate neonatal-risk communication and readiness due to sepsis/pneumonia/meningitis risk after birth.
Nursing Interventions
- Notify obstetric team promptly when chorioamnionitis criteria are met or strongly suspected.
- Initiate ordered broad-spectrum antibiotic therapy promptly and continue through the indicated perinatal period.
- Maintain continuous maternal-fetal monitoring and frequent reassessment for deterioration.
- Support infection-source and sepsis workup per protocol (cultures/labs as ordered) without delaying urgent treatment.
- Prepare postpartum surveillance for hemorrhage, endometritis, and maternal sepsis progression.
- Communicate neonatal infectious-risk status to newborn team for immediate postbirth assessment and treatment planning.
Maternal-Neonatal Deterioration Risk
Delayed treatment can rapidly increase risk of maternal sepsis and severe neonatal infectious morbidity.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Broad-spectrum intrapartum regimens | Start promptly in suspected infection and narrow based on culture/sensitivity when available. |
| intravenous-fluids | Isotonic fluid support context | Supports perfusion while infection and hemodynamic instability are managed. |
Clinical Judgment Application
Clinical Scenario
A laboring patient with prolonged rupture of membranes develops fever of 38.4 C, fetal tachycardia, uterine tenderness, and foul-smelling amniotic fluid.
- Recognize Cues: Fever, fetal-maternal tachycardia, uterine tenderness, and malodorous fluid.
- Analyze Cues: Pattern is highly concerning for chorioamnionitis with maternal-neonatal infectious risk.
- Prioritize Hypotheses: Immediate priority is infection control with prevention of sepsis progression.
- Generate Solutions: Activate urgent obstetric response, start antibiotics, intensify maternal-fetal monitoring, and coordinate newborn-team readiness.
- Take Action: Implement treatment protocol and escalate for instability.
- Evaluate Outcomes: Maternal-fetal status stabilizes and postpartum infectious complications are reduced.
Related Concepts
- maternal-sepsis - Chorioamnionitis is a major obstetric source of maternal sepsis.
- postpartum-infections - Postbirth follow-up should monitor for endometritis and other infection progression.
- postpartum-hemorrhage - Chorioamnionitis increases uterine-atony hemorrhage risk.
- disseminated-intravascular-coagulation-in-pregnancy - Severe infectious deterioration can overlap with coagulopathy pathways.
- care-of-common-problems-in-the-newborn - Neonatal infection surveillance is essential after intraamniotic infection exposure.
Self-Check
- Which findings most strongly support suspected chorioamnionitis during labor?
- Why must antibiotics begin promptly even before final culture confirmation?
- Which maternal and neonatal complications require highest-priority follow-up?