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Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistakeFrom: GA12L@aol.comThu Jan 26 04:50:06 2006
In a message dated 25/01/2006 20:24:29 GMT Standard Time, 530rose@msn.com writes: The only reason I usually use ROM is to prevent getting sprayed when she SROM's during a good push! The only reason I would do an ARM is for induction of labour or if labour has ground to a halt. Anyway, if a woman is being induced her membranes are ruptured prior to using syntocinon. That's the guideline from the RCOG. In multips sometimes an ARM is all that is needed and they labour without synt. Personally I prefer not to use synt so if doing an ARM gets a woman into labour I am all for it if it means not using synt. So when you induce women you don't do an ARM? Very interesting and I am sure you're right that it's not necessary to perform an ARM to use pitocin. I wonder why we do and what evidence there is to support what we do? Obviously there can't be any if the evidence supports not doing an ARM prior to using synt. .. We don't give prophylactic antibiotics for prolonged rupture of membranes unless we pick up an infection. The research and subsequent guideline recommends IOL takes place after 72 hours from ROM to allow for spontabeous labour to occur. So we are not forced to use antibiotics at all which is good news in light of hospital super bugs that we have here. I don't think the research supports the use of antibiotics prophylactically nor for labour to be induced asap after SROM but in order to provide evidenced based care I am happy to change when confronted by more research that contradicts what I think is right. And as for arguing for an intervention, IOL is an intervention in itself and that is one of the very few times I would ever consider an ARM. I have just worked 7 nights, supported 11 women through labour and birth performed NO vaginal examinations and NO ARM on any of them. Gail
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