Pregnancy Conditions & Complications

Archived User

Pregnancy Conditions & Complications
Cindy Whitman-Bradley:
I have questions about spontaneous rupture of membranes before labor begins. What are the safety guidelines. Hospitals in SF Bay area seem to want to induce if not immediately, at the latest by 24 hours. Just heard from a Japanese doctor that they wait 72 hours. Also wondering what causes membranes to rupture and not be followed soon by contractions. As a doula, wondering how I can help prevent this scenario.

Thank you so much for taking the time to be available to answer questions. I always look for your articles whenever I have questions.

Archived User

RE: Pregnancy Conditions & Complications
(in response to Archived User)
Henci Goer:
Here is what a Cochrane systematic review has to say about term prelabor rupture of membranes (PROM) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16437525: The primary concern is that waiting for spontaneous onset of labor will increase newborn infection rates, BUT early induction didn't reduce infection rates DESPITE the largest study in the review being in women who were rarely treated for group B strep and who had multiple vaginal exams and possibly internal monitoring, which would increase risk of infection. Early induction had a modest effect on reducing maternal infection rates (chorioamnionitis and endometritis) BUT this a worst case scenario for the reasons I just mentioned. On the other hand, early induction DIDN'T increase cesarean rates. Taken together, the findings that early induction for term PROM may decrease maternal infection rates without increasing c/sec rate tends to argue for early induction, but not compellingly so, especially considering, as the reviewers point out in their introduction, that 79% of women with term PROM will begin labor within 12 hr and 95% within 24 hr. This led the reviewers to conclude: “Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices.” "What about GBS-positive women?" you might ask. Waiting for 24 hr before inducing seems reasonable provided women get their prophylactic antibiotic treatment while waiting because it would allow the vast majority of women to begin labor on their own. In fact, it might even be better to wait at least until the antibiotic treatment regimen is completed because it is possible that once the induction is started, the labor might take off like gangbusters and the woman deliver before treatment is complete.

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