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chorioamnionitis...(spelling?)

MIA-RN1 MIA-RN1, RN (Member)

Ok, I may have spelled it wrong. We call it chorio on the unit. I am trying to get an understanding of it and its not covered well in my notes and at work we are always so busy there isn't much time.

I had a patient dx'd with it last night and likely will have her again today so I want to get into work knowing what is going on.

She was in labor, ROM, no progression. Epidural did not take, moved to Csect (I think for failure to progress) and then spinal did not take, finally went under general. I don't remember just now her GBS status.

Baby delivered, taken to NBN. Found to be tachypnic, but O2 sat well. Intermittent tachypnea seen by doctor, called prolonged transition, nurse told to watch and see.

Meanwhile mom comes out of OR w/ fever. Very painful abdomen.

She is started on Gent and Clinda, per protocol. But no one is calling it chorio. They are waiting to test placenta.

So I get report on mom, LD nurse calls NBN and tells her about fever, possible chorio that is not being called chorio. (I don't understand that)

Anyway, mom is afebrile when I get her, and stayed so the 4 hours or so that I cared for her. On a morphine PCA, pain very well controlled. Good urine output and tolerated my fundus exam about as well as anyone does post-csect.

Meanwhile, baby remains tachypnic, and transfers from NBN to Special care. Blood tests reaveal low whites and multiple bands.

So that means infection of some sort. Baby will receive 48h abx.

So here are my questions:

Is there a specific physiology of neonate that decreases wbc w/ infection vs adults who's wbc is elevated w/ infection? I am thinking its cause they are new, have not fought off infection before...I am not good w/ physiology lol.

I read on the web that chorio can lead to neuro problems such as cerebral palsy. Has anyone heard of this?

Finally, is chorio basically an infection of the amniotic fluid or the placenta, or both? And am I right in thinking that it can be caused by GBS or other vaginal infection? I had it in my head that there is another cause but I can't remember what exactly and I went thru my school notes to no avail. Is not a TORCH, right?

Thanks so much everyone! :)

Hi there.

I sort of remember a lady presenting with exactly the same symptoms as yours. And likewise baby taken to scbu for a while. Mum did have a TORCH screen and she was strep b positive. Sorry can't remember anything else apart from she was a c-section and had febrile convulsions. Sorry again but I was a senior midwifery student and had my own patient to look after. Only know this because I was covering the ladies midwife while she had lunch!!!!! As you can imagine my fear on the day!!! LOL

Not a nurse, (yet), but with my 2nd pg. I delivered at 33 weeks, due to "chorio secondary to GBS" according to my records.

Chorioamnionitis is defined as clinical signs of amniotic infection with fever, elevated WBC, foul smelling fluid, maternal or fetal tachycardia, and uterine tenderness.

Incidence:

1% of all pregnancies

Only 10% of neonates born to mothers with chorio will develop sepsis

Pathogenesis: Excess overgrowth of organisms within the vagina and cervical canal. Organism infects decidua, chorion and finally amnion and amniotic cavity. Fetus aspirates or swallows infected amniotic fluid or becomes infected by direct contact resulting in generalized sepsis.

Management: broad-spectrum antibiotics and deliver fetus.

Signs of infection can be an elevated or decreased WBC count in neonates and adults.

Yes, you are exactly right about chorio being linked with cerebral palsy. It has something to do with the inflammatory response and is more common in premature infants. Just remember that just because mom has chorio the baby isn't for sure going to have cerbral palsy it is just a slight increase in risk.

Good job on taking the initiative to learn more about your patient's disease process.

TiffyRN, ADN, BSN, PhD

Specializes in NICU. Has 27 years experience.

As for the baby's CBC. I'll add a little from a NICU perspective. We do a calculation of immature vs. mature cells. If I recall properly; Segs Neutrophils (I think also called stabs) are the mature cells, Bands, mylocytes & metamylocytes are immature. We calculate a ratio and if it is higher than 0.2 (or 0.3 depending on the MD on) it indicates an infection. My undestanding of the process is that the infection "eats" up the mature cells so the body starts trying to replace them to fight the infection but it can only produce the immature cells, so the number of immature cells rises as the number of mature cells drops. If the ratio is high enough the baby is considered to have a "left shift" or be "shifted".

And sorry about any spelling; we usually just say: segs, stabs, bands, mylo's. And there may be more types of immature cells. I just don't remember them as they are writen dow at work so we can do the calcuation properly.

Thank you to everyone who responded to this thread! :) :)

I did not end up assigned to the patient again tonight, mostly I think because they are doing tilework on our floors and we were divided up into different nursing stations because of the mess in the hallway.

I do appreciate the help and the info. as I have a better understanding now.

Tonight I had a pt w/ cellulitis--but that one I know about! :)

Thanks so much again!

Had a pt with chorio, everything is supposed to be infected and only treatment is delivery of the baby (viable or not). My patient was about 16 weeks and the fetal hr was 220's+. She had a fever and was at risk for endocarditis, her md performed a D&C on her and she did fine. I've heard of others that linger near the age of viability after water has broken and try to keep baby, mom ends up with bad infection.

Chorioamnionitis is defined as clinical signs of amniotic infection with fever, elevated WBC, foul smelling fluid, maternal or fetal tachycardia, and uterine tenderness.

Incidence:

1% of all pregnancies

That's astonishing. Where I work chorio is as common as dust bunnies. That can't be a good thing.

Altalorraine

Jolie, BSN

Specializes in Maternal - Child Health. Has 34 years experience.

I'm trying to figure out how that isn't chorio.

It makes me wonder if there is a reason why they don't want to diagnose it as chorio. Perhaps trying to avoid reporting an infection which would impact negatively on hospital statistics?

Incidence:

1% of all pregnancies

That's astonishing. Where I work chorio is as common as dust bunnies. That can't be a good thing.

I wonder if you are referring to an elevated temp as Chorio? That's what we call it when the maternal temp is over 100.4, and we start the antibiotics. I believe that's not really chorio, which will only be determined with labs and placenta specimen.

Maternal temp goes up a lot more frequently, and when we say "chorio", we only mean that we have sign of possible chorio. In that case we also call peds and keep the baby under close observation.

Someone correct me if I'm wrong.

SmilingBluEyes

Has 20 years experience.

Chorio as common as dust bunnies????

WOW I would love to know why. I see it so rarely. True chorio is not all THAT common. The 1% stat sounds about right.

Chorio as common as dust bunnies????

WOW I would love to know why. I see it so rarely. True chorio is not all THAT common. The 1% stat sounds about right.

Wow, I must be really lucky to have incompetent cervix, chorio, and a baby with Down syndrome all in the same pg.! I should start buying lottery tix I think, LOL!

SmilingBluEyes

Has 20 years experience.

With luck like that, you might want to hold onto your money. How is your baby today?

I wonder if you are referring to an elevated temp as Chorio? That's what we call it when the maternal temp is over 100.4, and we start the antibiotics. I believe that's not really chorio, which will only be determined with labs and placenta specimen.

Maternal temp goes up a lot more frequently, and when we say "chorio", we only mean that we have sign of possible chorio. In that case we also call peds and keep the baby under close observation.

Someone correct me if I'm wrong.

I think that is the reason why they didn't call it chorio at first. But it ended up being chorio after all. baby will stay for another 7 days for abx, mom goes home tomorrow.

With luck like that, you might want to hold onto your money. How is your baby today?

Yeah, I know! Actually my "baby" is doing great--he just turned 3--but I was thinking if the risk of chorio is 1%, my risk for Ds was somewhere around 1 in 800 I think...who knows about IC, then you multiply those together right? (Its been a long time since I took statistics!) so if I hit those odds, the lottery can't be too much harder!

RNfromMS

Specializes in StepDown ICU, L&D. Has 4 years experience.

Chorio as common as dust bunnies????

WOW I would love to know why. I see it so rarely. True chorio is not all THAT common. The 1% stat sounds about right.

When I first started reading this thread, I thought the same thing about that I see it more often than that. However, in further processing, I would think it may be 1% of our patient population; however, we are a high risk unit, deliver lots of babies and have a whole lot of PPROM patients. Maybe that's why I (and maybe the other poster, too) thought it was more common.

Also, if the PPROMer has an elevated temp (>101F) and tender to touch abdomen, the docs are going to call her "suspected chorio" and start the regimen. If things do not improve drastically in a predetermined amount of time, they are going to call her chorio and deliver the baby. Of course, all our placentas on these patients go to pathology and I haven't heard the actual statistics from that. (But they haven't stopped handling them this way, so it can't be too off.)

Just my 2 cents.

how many VE's do you do generally?

I haven't followed up on placental pathology reports, so I have no idea of the true incidence where I work; however, it's more than just a lot of elevated temps and tachy babies. We see a fair number of foul-smelling babies.

As for why, I suppose it's a combination of being high risk unit where we have a lot of PPROMers, poor hygiene, women who don't come in for several days after their water broke, and too many vaginal exams.

Altalorraine

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