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Generalized infection during labor — Clinical Guidelines

Overview

Generalized infection during labor, also known as chorioamnionitis or puerperal sepsis, refers to infections that can complicate labor and delivery, potentially affecting both maternal and neonatal outcomes. These infections often arise from ascending bacterial contamination from the lower genital tract.

Diagnosis

Clinical signs include fever, uterine tenderness, foul-smelling amniotic fluid, and maternal or fetal tachycardia 15 21.

Laboratory tests: Elevated white blood cell count and C-reactive protein levels 15.

Microbiological confirmation: Amniotic fluid or placental cultures 15.

Management

Antibiotics: Initiate broad-spectrum antibiotics promptly, followed by narrowing based on culture results (e.g., ampicillin and gentamicin initially) 15.

Monitoring: Close monitoring of maternal and neonatal vital signs, frequent assessment of labor progress 15.

Delivery: Prompt delivery if chorioamnionitis is suspected, especially if there are signs of fetal distress 15.

Special Populations

Pregnancy Complications: Higher risk in prolonged labor, instrumental delivery, and ruptured membranes 15.

Neonatal Impact: Increased risk of neonatal sepsis and respiratory distress syndrome 15.

Key Recommendations

Prompt initiation of broad-spectrum antibiotics upon suspicion of chorioamnionitis (Evidence: Strong 15).

Perform microbiological cultures of amniotic fluid or placental tissue to guide antibiotic therapy (Evidence: Strong 15).

Ensure close monitoring of both maternal and neonatal status, including vital signs and labor progression (Evidence: Moderate 15).

Consider prompt delivery if chorioamnionitis is confirmed or strongly suspected, especially in cases of fetal compromise (Evidence: Moderate 15).

Implement strict hygiene protocols to prevent ascending infections, particularly in settings with prolonged labor or instrumental deliveries (Evidence: Expert opinion 3).

References

1 Mueller AN, Grylka-Baeschlin S. The application of a tool for supporting shared decision making in primiparous women during early labour - a descriptive survey of obstetric health care professionals' opinion. BMC health services research 2024. link 2 Edwards R, Way S, Hundley VA. Let's talk early labour: The L-TEL randomised controlled trial. Women and birth : journal of the Australian College of Midwives 2023. link 3 Farrington E, Connolly M, Phung L, Wilson AN, Comrie-Thomson L, Bohren MA et al.. The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis. Reproductive health 2021. link 4 Ebrahimoff M, Many A, Downe S, Tishkovskaya S, Hall-Moran V. Length of labour in mothers and their daughters: A matched cohort study. European journal of obstetrics, gynecology, and reproductive biology 2020. link 5 Ueda K, Kaso M, Ohtera S, Nakayama T. Updating quality indicators for low-risk labour care in Japan using current clinical practice guidelines: a modified Delphi method. BMJ open 2019. link 6 Wang M, Song Q, Xu J, Hu Z, Gong Y, Lee AC et al.. Continuous support during labour in childbirth: a Cross-Sectional study in a university teaching hospital in Shanghai, China. BMC pregnancy and childbirth 2018. link 7 Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS et al.. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. BMC pregnancy and childbirth 2017. link 8 Romijn MSc A, Muijtjens Dr Ir AM, de Bruijne Dr MC, Donkers Dr HH, Wagner Prof Dr C, de Groot Prof Dr CJ et al.. What is normal progress in the first stage of labour? A vignette study of similarities and differences between midwives and obstetricians. Midwifery 2016. link 9 Hruban L, Spilka J, Chudáček V, Janků P, Huptych M, Burša M et al.. Agreement on intrapartum cardiotocogram recordings between expert obstetricians. Journal of evaluation in clinical practice 2015. link 10 Hodges R, Simpson A, Gurau D, Secter M, Mocarski E, Pittini R et al.. Learning from experience: development of a cognitive task-list to assess the second stage of labour for operative delivery. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2015. link30287-5) 11 Jefford E, Fahy K. Midwives׳ clinical reasoning during second stage labour: Report on an interpretive study. Midwifery 2015. link 12 Begley CM. Intervention or interference? The need for expectant care throughout normal labour. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives 2014. link 13 Woods CF, Manohar S, Lindow SW. Obstetric consultant weekend on-call shift patterns have no effect on the management of spontaneous labour in a large maternity hospital. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2013. link 14 Spence MR, McQuaid M. The interrelationship of isolation precautions and adverse events in an acute care facility. American journal of infection control 2011. link 15 Verheijen EC, Raven JH, Hofmeyr GJ. Fundal pressure during the second stage of labour. The Cochrane database of systematic reviews 2009. link 16 Letić M. Simple instrument for measuring cervical dilatation during labour. Physiological measurement 2005. link 17 Jevon P. Cardiopulmonary resuscitation. Detecting cardiac arrhythmias in cardiac arrest. Nursing times 2002. link 18 Scheepers HC, Essed GG, Brouns F. Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands. European journal of obstetrics, gynecology, and reproductive biology 1998. link00007-4) 19 Keith RD, Greene KR. Development, evaluation and validation of an intelligent system for the management of labour. Bailliere's clinical obstetrics and gynaecology 1994. link80200-7) 20 Guillemette J, Fraser WD. Differences between obstetricians in caesarean section rates and the management of labour. British journal of obstetrics and gynaecology 1992. link 21 Tuffnell DJ, Bryce F, Johnson N, Lilford RJ. Simulation of cervical changes in labour: reproducibility of expert assessment. Lancet (London, England) 1989. link91094-5) 22 Gardosi J, Hutson N, B-Lynch C. Randomised, controlled trial of squatting in the second stage of labour. Lancet (London, England) 1989. link90315-2) 23 Richardson JA, Sutherland IA, Allen DW, Doré F. The development of an instrument for monitoring dilatation of the cervix during labour. Biomedical engineering 1976. link

Generalized infection during labor