A nurse is caring for a pregnant client at 32 weeks gestation who has been diagnosed with chorioamnionitis. Which nursing intervention should be the priority?

Chorioamnionitis is a serious intrauterine infection requiring immediate delivery and antibiotics to prevent maternal sepsis and fetal complications. Other interventions like fever reduction or positioning are supportive but do not address the underlying infection.

Understanding Chorioamnionitis and the Priority Intervention

Chorioamnionitis is an acute inflammation of the fetal membranes (chorion and amnion), typically caused by an ascending polymicrobial bacterial infection originating from the lower genital tract. The condition poses an immediate and serious threat to both the pregnant client and the fetus, with risks including maternal sepsis, preterm labor, fetal tachycardia, and neonatal sepsis. The provided research underscores the strong association between chorioamnionitis and preterm premature rupture of membranes (PPROM), highlighting it as a frequent and severe complication ^[3]. A key mechanism involves a shift from a healthy, Lactobacillus-dominant vaginal microbiome to a state of dysbiosis, which facilitates the ascent of pathogenic bacteria ^[2]. Once infection is established in the uterine cavity, the inflammatory cascade can trigger preterm birth and contribute to adverse outcomes like low birth weight .

When prioritizing care for a client at 32 weeks gestation with chorioamnionitis, the nurse must apply a clinical reasoning framework that addresses the root cause of the problem. The fundamental pathophysiological principle is that the infected fetal membranes and amniotic fluid serve as a continuous source of bacteria and inflammatory mediators. As long as the products of conception remain in utero, the infection cannot be fully eradicated, and the risks of maternal sepsis and fetal compromise escalate.

Analysis of the Options

1. Administer acetaminophen for fever reduction: Fever is a clinical sign of the underlying infection and a contributor to fetal tachycardia and maternal discomfort. While administering an antipyretic is a supportive measure that addresses a symptom, it does not halt the infectious process. Treating the fever without eliminating the source of infection provides only temporary relief and delays definitive care.



2. Encourage increased fluid intake to prevent dehydration: Fever and the hypermetabolic state of infection increase insensible fluid loss, making hydration an important supportive intervention. However, like fever management, fluid resuscitation is an adjunctive therapy. It stabilizes the maternal hemodynamic status but does not resolve the primary pathology of intra-amniotic infection.



3. Position the client in left lateral position to improve fetal circulation: The left lateral position is a standard intervention to relieve aortocaval compression, thereby maximizing uteroplacental blood flow and fetal oxygenation. In the context of chorioamnionitis, where the fetus is already stressed by an inflammatory environment, optimizing circulation is beneficial. Nevertheless, this intervention is supportive and does not address the ongoing infectious insult to the fetoplacental unit.



4. Prepare for immediate delivery and administer prescribed antibiotics: This is the definitive and priority intervention. The cornerstone of chorioamnionitis management involves two concurrent actions: administering broad-spectrum intravenous antibiotics to combat the systemic infection and proceeding with delivery to evacuate the infected uterine contents. The research confirms that chorioamnionitis is a major driver of adverse birth outcomes, and its presence necessitates prompt delivery to mitigate maternal and neonatal morbidity [1, 4]. Antibiotics treat the maternal bacteremia and begin fetal protection, but delivery is the ultimate source control. Therefore, the nurse’s priority is to initiate preparations for delivery while ensuring the prescribed antibiotic therapy is administered without delay.

The correct answer is 4. While options 1, 2, and 3 are all appropriate nursing actions for a client with chorioamnionitis, they are supportive measures. The priority intervention is the one that directly addresses the etiology of the condition by facilitating source control (delivery) and treating the infection systemically (antibiotics).