Dr. Rhona Mahony:

The point is what is the law under which we practise.

In respect of ruptured membranes, when I say it takes 48 hours to obtain a microbiology culture, that is not a deficiency. It is just what it is. Some more rapid tests are becoming available in which we can look at polymerase chain reaction, PCR, or viral material directly in the laboratory and get quicker results, but at present, for practical purposes, it takes us 48 hours to get confirmation on a laboratory specimen, to actually grow the bugs to determine that there is chorioamnionitis. Therefore, we make our clinical decision based on clinical signs and symptoms that might suggest there is chorioamnionitis. It is most likely to occur in the case of a ruptured membrane and the signs and symptoms of infection we look for are temperature, rapid pulse rate, hypotension, all of the things we measure all the time. The difficulty is that infection can be sub-clinical and when it does take hold, the clinical course can be very rapid and women can become very sick.