Evaluation by Physician During Labor Health Article

Periodic exams during labor by your health care provider will help diagnose potential complications in either mother or baby as soon as possible. Complications at time of delivery are usually being evaluated while they are occurring. How frequently your physician or other health care provider should examine and/or evaluate the mother during labor is a matter of much controversy.

Diagnosis of Bleeding

The diagnosis of excessive bleeding is based on the clinical judgment of the health care provider. Once bleeding is noted, the source must be identified. Common sources include the placenta, the uterus, and the tissue of the vagina and perineum. The goal is to stop excessive bleeding.

Diagnosis of Amnionitis

Amnionitis is usually identified because of clinical suspicion. Clinical suspicion refers to a suspected diagnosis based on the patient's history and symptoms, which is then confirmed by physical examination and laboratory testing. Other illnesses present symptoms similar to amnionitis (including appendicitis and severe kidney infection). The most accurate way to diagnose amnionitis is to identify bacteria in the amniotic fluid. To do this, a sample of amniotic fluid must be obtained through a procedure called amniocentesis. This applies to infections prior to the onset of labor. In active labor, amnionitis can be identified by maternal infection, fetal tachycardia (fast heart rate), and uterine tenderness.

Amniocentesis

Amniocentesis is a technique for sampling amniotic fluid for testing. First, the skin of the mother's abdomen is cleaned with a disinfecting solution (to minimize the risk of introducing infection). Ultrasound is then used to locate a pocket of amniotic fluid and to guide the needle into that pocket. Once the pocket is reached, a few tablespoons of amniotic fluid are withdrawn. The use of ultrasound during the entire procedure is critical to ensure the proper angle of the needle and to watch for fetal movement. This procedure can be performed with minimal risk to both the mother and the fetus. Occasionally, this procedure can cause the amniotic membrane to rupture, but when indicated, this risk is very small compared to the risk of failing to diagnose a uterine infection, which can infrequently lead to fetal death.

Tests

Three tests are performed on the fluid to verify the presence of infection. Two of these tests provide rapid results: the gram stain test and the amniotic fluid glucose level.

The gram stain involves the staining for bacteria to be identified under a microscope. A normal gram stain does not show any signs of bacteria; presence of a few white blood cells is normal. In cases of amnionitis, the gram stain reveals bacteria and a large number of white blood cells. The glucose test is the second test that provides immediate information. The glucose level is reduced when bacterial infection is present because glucose is an energy source for bacteria.

A culture for bacteria is the third test performed. The amniotic fluid is sent to the microbiology laboratory where it is cultured to allow bacteria to grow and be identified. Because it can take up to 48 hours to identify bacteria in culture, these results are generally used to confirm the diagnosis. In addition, once the bacteria are identified, they can be tested to see which antibiotics would be most effective for treatment. This information is useful because both mother and newborn will be treated for infection after delivery.

For information about high blood pressure in pregnancy, go to What is Hypertension in Pregnancy?.

For information about bleeding, go to Pregnancy Complications: Common Causes of Hemorrhage or What is the Placenta?.

For information about infection of the uterus, go to Pregnancy Complications: Amnionitis.