Chorioamnionitis Flashcards
Why is choriomanionitis important
Main cause of sepsis in pregnancy
Stages of perinneal tears
4
What is more common in macrosomic babies
Peronneal tears
shoulder dystocia
Post partum haemorrhage- prophylaxis
What is the other main cause in pregnancy of sepsis except chorioamnionitis?
UTI
What is choriomanionitis
Infection of choriomanitoic membranes and amniotic fluid
Usually occurs in late pregnancy or labour
What is the upper segment of uterus
Muscular
Lower segmanet is comparatively thin and less vascular, develops in pregnancy
Heals much better therefore use in C section
What cn choriomnionitis cuased by>
Grma +, gram - bacteria
anaerobes
MEOWS
Maternal early obstetruc warning system
Non specific signs of sepsis
- Fever
- Tachycardia
- Raised respiratory rate (often an early sign)
- Reduced oxygen saturations
- Low blood pressure
- Altered consciousness
- Reduced urine output
- Raised white blood cells on a full blood count
- Evidence of fetal compromise on a CTG
Additional signs and symptoms related to chorioamnionitis causing sepsis
Abdominal pain
Uterine tenderness
Vaginal discharge
Additional signs and symptoms related to a urinary tract infection causing sepsis
- Dysuria
- Urinary frequency
- Suprapubic pain or discomfort
- Renal angle pain (with pyelonephritis)
- Vomiting (with pyelonephritis)
Investigations for choriomanionitis
- Full blood count to assess cell count including white cells and neutrophils
- U&Es to assess kidney function and for acute kidney injury
- LFTs to assess liver function and as a possible source of infection (e.g. acute cholecystitis)
- CRP to assess inflammation
- Clotting to assess for disseminated intravascular coagulopathy (DIC)
- Blood cultures to assess for bacteraemia
- Blood gas to assess lactate, pH and glucose
Additional investigations based on sus source of infection
- Urine dipstick and culture
- High vaginal swab
- Throat swab
- Sputum culture
- Wound swab after procedures
- Lumbar puncture for meningitis or encephalitis
Management choruomanipnitis
Senior obstetricians and midwives should be involved early in care
Early recongition and management essential
Sepsis six
Continuous maternal and foetal monitoring
May need early delivery
Emergency C section - foetal distress
How anaesthetise women w sus sepsis?
General - avoid spinal anaesthetic
