Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Chorioamnionitis

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In one line

·Bacteria have infected the amniotic sac and the membranes that protect the baby during pregnancy.

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Normal physiology

·Two thin membranes—the amnion (inner layer) and the chorion (outer layer)—seal around the baby like a sterile balloon filled with amniotic fluid. A thick mucus plug sits in the cervix, blocking bacteria from the vagina from climbing up into the uterus. This clean, closed system keeps the baby safe from infection throughout pregnancy.

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What goes wrong

·The protective barrier breaks down, and bacteria that normally live in the vagina climb up into the uterus and invade the amniotic sac and membranes.

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Hallmark signs

·Fever above 100.4°F (38.0°C) in mom during labor
·Baby's heart rate stays fast (above 160 beats per minute)
·Mom's heart rate stays fast (above 100 beats per minute)
·Uterus (womb) feels tender or painful when the doctor presses on the belly
·Foul-smelling or cloudy fluid leaking from the vagina
·White blood cell count above 15,000 per microliter
·Mom feels shaky, chilled, or sweaty
·Low blood pressure or mom feeling dizzy and weak

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Red flags · escalate now

·Mom's blood pressure dropping or she feels faint (possible sepsis, meaning infection spreading through the whole bloodstream)
·Baby's heart rate showing late decelerations or staying very low (sign the baby is not getting enough oxygen)
·Mom confused, extremely sleepy, or not responding normally (infection may be affecting the brain)
·Foul-smelling, green, or pus-like fluid coming from the vagina (heavy bacterial load)
·Mom's breathing becomes fast and shallow or she struggles to breathe (infection may be reaching the lungs or causing severe inflammation)

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Workup

·Complete blood count (CBC) with differential
·Maternal blood cultures (two sets from different sites)
·C-reactive protein (CRP) or procalcitonin
·Amniotic fluid Gram stain and culture (if amniocentesis is done)
·Fetal heart rate monitoring (continuous electronic)
·Urine culture

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Treatment

·Intravenous ampicillin plus gentamicin; add clindamycin or metronidazole if cesarean delivery is done
·Deliver the baby promptly (vaginally if labor is progressing well, or by cesarean if labor is stalled or the baby shows distress)
·Continue intravenous antibiotics until mom has been fever-free for at least 24 hours after delivery
·Alert the neonatology team and evaluate the newborn for early-onset sepsis (blood culture, CBC, and antibiotics if indicated)
·Acetaminophen for fever control
·Intravenous fluids to maintain hydration

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NCLEX trap

·Chorioamnionitis needs fever (temperature 38°C or higher) PLUS at least one other sign: the uterus hurts when you touch it, the baby's heart beats too fast (over 160), mom's heart beats too fast (over 100), or the fluid smells bad. Fever by itself could be from an epidural, dehydration, or another infection. Match the full picture: bacteria climbed up into the uterus and the sac holding the baby.
·Antibiotics kill bacteria, but they cannot take out the infected fluid, placenta, and membranes still sitting inside the uterus. The only way to truly fix chorioamnionitis is to deliver the baby—either through the vagina or by cesarean section. Antibiotics help, but delivery is the cure.
·Start broad-spectrum antibiotics (ampicillin plus gentamicin, often plus clindamycin for cesarean or if labor is not progressing) the moment you suspect chorioamnionitis. Do not wait. Both mom and baby are in danger right now. Cultures tell you later if you need to change the antibiotic, but they never delay the start.
·Chorioamnionitis is an infection shared by mom and baby. Before birth, the baby floats in and swallows amniotic fluid full of bacteria. After delivery, the newborn has a high chance of sepsis (bacteria in the blood), pneumonia (bacteria in the lungs), and meningitis (bacteria around the brain). Always alert the baby's team so they can examine, watch, and treat the newborn.
·Keep giving antibiotics for at least 24 hours after the fever is gone and mom has delivered. Stopping too soon lets bacteria grow back. Chorioamnionitis is a deep infection that needs time to clear completely.
·Chorioamnionitis happens most often after the membranes rupture (the water breaks), but bacteria can still climb up through the cervix or travel through the blood even when the bag is intact. Do not cross chorioamnionitis off your list just because membranes are whole.

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