Patient case #5 – A difficult case: Chorioamnionitis with hypoxia 

Infection and hypoxia is a dangerous combination. In this case the patient was admitted with prolonged rupture of membranes, however at the beginning of labour there were no signs of infection. Many hours later, the picture changes when clinical chorioamnionitis is identified. How do you identify chorioamnionitis on the CTG trace, how does it affect your management plan and where does ST analysis fit into the picture? Always remember – ST analysis is a test for hypoxia, not for infection.

Patient background

• 28 years of age, BMI 25
• Previous vaginal birth
• Antenatal period – uneventful
• USS 36W – EFW 59th centile, A. fluid & dopples

• 39 weeks + 5 days
• Admitted to LW with prolonged ruptured of membranes
• Not contracting
• Maternal pulse 82 bpm
• BP – 120/85mmHg