NCLEX Review Guide: Chorioamnionitis

Understanding Chorioamnionitis

• Chorioamnionitis is an infection of the chorion, amnion, and amniotic fluid that occurs during pregnancy or labor, most commonly caused by ascending bacterial infection from the vagina and cervix.
• The infection typically develops when prolonged rupture of membranes (>18 hours) allows bacteria to ascend into the amniotic cavity, creating a pathway for maternal and fetal complications.

High-Risk Conditions

• Prolonged rupture of membranes (>18 hours), prolonged labor (>12 hours), and multiple vaginal examinations increase bacterial exposure and infection risk.
• Maternal factors include young maternal age, nulliparity, bacterial vaginosis, and immunocompromised status that predispose to ascending infections.

Clinical Signs and Symptoms

• Maternal fever >100.4°F (38°C) is the most common and earliest sign, often accompanied by maternal tachycardia >100 bpm and uterine tenderness.
• Foul-smelling amniotic fluid, purulent vaginal discharge, and fetal tachycardia >160 bpm indicate advancing infection requiring immediate intervention.

Priority Assessments

1. Monitor maternal vital signs every 15-30 minutes, focusing on temperature trends and tachycardia as early infection indicators.
2. Assess fetal heart rate continuously for fetal tachycardia, decreased variability, or late decelerations indicating fetal compromise.
3. Evaluate uterine tenderness, contraction patterns, and characteristics of amniotic fluid for color, odor, and consistency changes.
4. Document time of membrane rupture and number of vaginal examinations to assess infection risk factors.

Therapeutic Interventions

• Immediate antibiotic therapy with broad-spectrum antibiotics (typically ampicillin and gentamicin) should be initiated promptly to prevent maternal sepsis and fetal complications.
• Expedite delivery through labor augmentation or cesarean section based on cervical readiness and fetal status to remove the infected environment.

Maternal Complications

• Sepsis and septic shock can develop rapidly, requiring intensive monitoring of blood pressure, urine output, and mental status changes.
• Postpartum complications include endometritis, wound infections, and thromboembolism requiring extended antibiotic therapy and close monitoring.

Fetal/Neonatal Complications

• Neonatal sepsis occurs in 5-10% of cases, requiring immediate pediatric evaluation and potential antibiotic treatment of the newborn.
• Long-term complications may include cerebral palsy, developmental delays, and respiratory distress syndrome due to intrauterine infection exposure.

Common Pitfalls

• Don't wait for all symptoms - fever alone with risk factors warrants treatment initiation.
• Don't delay antibiotics for culture results - broad-spectrum coverage should begin immediately upon diagnosis.
• Remember that fetal tachycardia may be the first sign before maternal fever develops.