Assessment

HISTORY. Ask about the last menstrual period to determine the estimated date of delivery and the gestational age of the fetus. Inquire about any past history of vaginal infections or STIs. Question the patient as to the presence of any perineal pain, burning, malaise, or chills. Ask the patient if she is feeling contractions or if she has noted any leakage of the amniotic fluid. If the amniotic sac has ruptured, determine the time it occurred, the color of the fluid, and if the patient noted any odor. Also consider any prenatal tests or procedures, such as placement of a cerclage, chorionic villi sampling, intrauterine transfusions, or amniocentesis, that can predispose the patient to developing an intrauterine infection.

PHYSICAL EXAMINATION. Early clinical findings in patients with chorioamnionitis may be vague. Assess the patient's vital signs; patients with chorioamnionitis often display an elevated pulse above 120 beats per minute and temperature above 100.4°F. Palpate all quadrants of the abdomen for tenderness, noting the maternal response during examination of each quadrant. Foul odor of the vaginal discharge, color change of amniotic fluid from clear to light yellow to green, and an increase in the purulence of vaginal drainage are all consistent with chorioam-nionitis.

Often, preterm labor patients with undiagnosed chorioamnionitis have contractions that do not respond to routine treatments of intravenous hydration and tocolytic therapy. Evaluate the baseline fetal heart rate. Fetal tachycardia, heart rate above 160 beats per minute, or decreased fetal heart rate, below 110 beats per minute, or decreased variability may be present with chorioamnionitis.

PSYCHOSOCIAL. Increased anxiety is usually present with patients who are experiencing preterm labor, premature rupture of membranes, or a history of a cerclage placement. Assess the patient's understanding of the situation, and encourage the patient to express her fears. Also include an assessment of the patient's social support and the response of significant others to the patient's condition.

Diagnostic Highlights

General Comments: Diagnosis may be difficult to establish early on because symptoms are vague. Examination of amniotic fluid is definitive.

Abnormality with Test Normal Result Condition

Explanation

Amniocentesis No growth Growth of infecting or endocervical organism culture

Culturing the amniotic fluid will reveal the presence of a causative organism, allowing for appropriate choice of antibiotic therapy

Other Tests: Complete blood count (CBC) with differential, urinalysis

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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Responses

  • stig
    What physical examination for vre?
    7 years ago

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