Chorioamnionitis: Prevention and Management

Summary:

Chorioamnionitis is now a rising issue in Maternal and Child care when it comes
to safe and effective care during delivery. Chorioamnionitis is one of the problems for
both neonate and laboring women. It is also known as intramniotic infection, a
histopathologic finding of inflammation of the fetal membranes and may extend to the
umbilical cord. Commonly results from polymicrobial infection of the amniotic fluid; fetal
membrane placenta or uterus. Chorioamnionitis (also called amnionitis or intra-amniotic
infection) is a bacterial infection that occurs either before or during labor. The name
refers to the outer membrane (chorion) and the fluid-filled sac (amnion) that encloses
the embryo. Chorioamnionitis affects between 1 and 10% of women at term and up to
33% of patients who deliver preterm.
Since it occurs more often during labor; women are at risk for endometritis,
cesarean section and postpartum hemmorhage as well as the neonates risk for fetal
distress and sepsis and even death. Numbers of factors are being considered that
increase the risk of chorioamnionitis, including use of intrauterine pressure catheters
and fetal scalp electrodes, urogenital tract infections, prolonged rupture of membranes,
digital vaginal examinations and the nature of perineal hygiene.
Choriomnionitis may be clinical or subclinical. Assessment in determining the
said complication is crucial. Maternal fever and fetal tachycardia, maternal leukocytosis
on Complete Blood Count, uterine tenderness and purulent foul smelling amniotic fluid
are believed to be the signs and symptoms of chorioamnionitis. However it is not well
understood how the profiles of circulating inflammatory cytokines and infant responses
to infection. A definitive diagnosis of chorioamnionitis is through amnionitic fluid culture
but is not often performed. Amniotic fluid glucose, gram-staining, c-reactive protein and
determination of inflammatory cytokines can help on the diagnosis of such disease. On
the other hand, management for chorioamnionitis is not that directive since it is
somehow difficult to diagnose. Many healthcare provider treat chorioamnionitis based
solely on fever, others require use of two or three clinical findings as a criteria for
treatment. Timely administration of intrapartum antibiotics, as well as antipyeretics has
been proven to be significant in reducing incidence of postpartum maternal and
neonatal complications. An important intervention is antenatal education that should be
emphasized to laboring mothers. The laboring behaviors that minimize the risk of
chorioamnionitis with epidural use. Elective inductions should be discourage as they
increase invasive interventions. Other invasive procedures without clear purpose should
be also avoided as they increase the risk for chorioamnionitis.
Moreover, vaginal irrigation with chlorhexidine has been found out to be an
alternative in the prevention of chorioamnionitis but is not recommended. More frequent
perineal hygiene likely decrease the risk of developing chorioamnionitis in term women.
Perineal care is generally a responsibility of nurses to ensure care. Interventions that
are known to interfere with normal bith processes such as epidural administration and
internal monitoring are in particular need of rigorous examination.


Reflection:

The WHO has long held that in normal birth, there should be a valid reason for
interfering with the natural process. Nurses and midwives are the standard bearers for
care that promotes safe and normal birth. Patients should be safeguarded from
practices that reduce the likelihood of normal birth and risk for adverse outcomes such
as chorioamnionitis.
Similar to what WHO stated, it is a major responsibility of the Nurses and
Midwives to ensure quality health care for laboring women was being given to prevent
the occurence of chorioamnionitis. Preterm birth is a major cause of perinatal mortality
and long-term morbidity. Chorioamnionitis is a common cause of preterm birth. Clinical
chorioamnionitis, characterised by maternal fever, leukocytosis, tachycardia, uterine
tenderness, and preterm rupture of membranes, is less common than
subclinical/histologic chorioamnionitis, which is asymptomatic and defined by
inflammation of the chorion, amnion, and placenta. Chorioamnionitis is often associated
with a fetal inflammatory response. The fetal inflammatory response syndrome (FIRS) is
defined by increased systemic inflammatory cytokine concentrations, funisitis, and fetal
vasculitis. Clinical and epidemiological studies have demonstrated that FIRS leads to
poor cardiorespiratory, neurological, and renal outcomes.
Proper assessment is very crucial in determining such complication. Awareness
of pregnant women during the beginning of labor through health teaching was indeed a
great help. Chorioamnionitis can lead to serious complications in both mother and baby
and is usually considered a medical emergency. Available clinical, epidemiological, and
experimental data indicate that chorioamnionitis plays a significant role in predisposing
the preterm infant to multiple organ disease. Further investigation is required to improve
our understanding of the mechanisms underlying the changes in development and
function of the preterm cardiorespiratory, central nervous, visual, and renal systems.
Improved antenatal screening for chorioamnionitis and identification of effective
treatment strategies for preterm infants exposed to intrauterine inflammation will likely
provide a better prognosis for infants at risk of multiple organ disease as a result of
exposure to inflammation before birth.