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Re: Term PROM From: ainsron (ainsron@sbcglobal.net) Thu Oct 18 11:35:27 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dean Huffman .: "Dead: SCHIP" Previous message: Andrew Folley: "Re: Term PROM" In reply to: Efrain Ramirez: "Re: Term PROM" Next in thread: Meenan, Anna L.: "Re: Term PROM" That is exactly why we decided (in our community) to send all GBS cultures to the hospital lab, results are always available, 24/7. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez Sent: Thursday, October 18, 2007 6:53 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Term PROM Her last visit was at 35-36 weeks - no notification of GBS status.. Sunday - Lab is closed .. Ef CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN-GYNECOLOGISTS NUMBER 80, APRIL 2007 (Replaces Practice Bulletin Number 1, June 1998) "What is the optimal method of initial management for a patient with PROM at term? Fetal heart rate monitoring should be used to assess fetal status. Dating criteria should be reviewed to assign gestational age because virtually all aspects of subsequent care will hinge on that information. Because optimal results are seen with 4 hours between group B streptococcal prophylaxis and birth, when the decision to deliver is made, group B streptococcal prophylaxis should be given based on prior culture results or risk factors if cultures have not been previously performed (60). The largest randomized study to date found that oxytocin induction reduced the time interval between PROM and delivery as well as the frequencies of chorioamnionitis, postpartum febrile morbidity, and neonatal antibiotic treatments, without increasing cesarean deliveries or neonatal infections (25). These data suggest that for women with PROM at term, labor should be induced at the time of presentation, generally with oxytocin infusion, to reduce the risk of chorioamnionitis. An adequate time for the latent phase of labor to progress should be allowed." Summary of Recommendations and Conclusions The following recommendations and conclusions are based on good and consistent scientific evidence (Level A): For women with PROM at term, labor should be induced at the time of presentation, generally with oxytocin infusion, to reduce the risk chorioamni-onitis Premature rupture of membranes at term: a meta-analysis of three management schemes. Mozurkewich EL, Wolf FM Obstet Gynecol (1997 Jun) 89(6):1035-43 ISSN: 0029-7844 Fetal Membranes, Premature Rupture Clinical Protocols Female Human Pregnancy Support, U.S. Gov't, P.H.S. Meta-Analysis Medline Database Healthstar Database Abstract OBJECTIVE: To compare rates of cesarean birth, endometritis, chorioamnionitis, and serious neonatal infections among pregnancies complicated by premature rupture of membranes (PROM) at term and managed by immediate oxytocin induction, by conservative management (or delayed oxytocin induction), or by vaginal (or endocervical) prostaglandin E2, gel, suppositories, or tablets. DATA SOURCES: The English-language literature in MLD, LINE and other databases was searched through April 1996 using the terms "fetal membranes," "premature rupture," and "term." METHODS OF STUDY SELECTION: We included randomized trials comparing two or more management schemes for PROM at term. TABULATION, INTEGRATION, AND RESULTS: Twenty-three studies with a total of 7493 subjects met the inclusion criteria and were included for analysis. Data regarding chorioamnionitis, endometritis, neonatal infections, and Top of Abstract cesarean delivery were extracted. Meta-analyses were performed for the three interventions for these outcomes of interest using the Der-Simonian and Laird and Mantel-Haenszel techniques to estimate the pooled odds ratios (ORs). No statistically significant differences in cesarean deliveries or neonatal infections were noted among management schemes. Vaginal prostaglandins resulted in more chorioamnionitis than immediate oxytocin (OR 1.55, 95% confidence interval [CI] 1.09, 2.21), but less chorioamnionitis than conservative management (OR 0.68, 95% CI 0.51, 0.91). Immediate oxytocin induction resulted in fewer cases of chorioamnionitis (OR 0.67, 95% CI 0.52, 0.85) and endometritis (OR 0.71, 95% CI 0.51, 0.99) than conservative management, although these results achieved significance only with the Mantel-Haenszel technique. CONCLUSION: Conservative management may result in more maternal infections than immediate induction with oxytocin or prostaglandins. At Thu, 18 Oct 2007, Betsy Hyde wrote: > >On Oct 18, 2007, at 7:41 AM, Efrain Ramirez wrote: > >> 34 y/o, GI, 38 6/7 weeks - SROM at 8PM - arrives at LDR 9PM - 1-2 >> cm/75%/-1- soft. almost no contractions...baby fine... last visit 35 >> weeks - GBS done - results not available.. options.. > >There is no indication for starting antibiotics or pitocin at this >point. With unknown GBS status, CDC recs are to treat based on risk >factors (<37 weeks, PROM >18 hours, prior GBS sepsis). It seems that >if she had been GBS +, someone would have notified her of that fact >when the results came in. > >I would give her overnight to get into labor,and if not, induce her >in the morning. > >-- >Betsy Hyde CNM >Branford, CT > -- " The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge." Daniel J. Boorstin - Historian Next message: Dean Huffman .: "Dead: SCHIP" Previous message: Andrew Folley: "Re: Term PROM" In reply to: Efrain Ramirez: "Re: Term PROM" Next in thread: Meenan, Anna L.: "Re: Term PROM"

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