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Re: NEJM TERMPROM From: CheriVH@aol.com Fri Apr 26 09:32:14 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: dahmd@gate.net: "Re: HPV" Previous message: Anna Nickels: "Inductions, macrosomia, and a question" Maybe in reply to: Geff Klein: "NEJM TERMPROM" Next in thread: DoctorJoe@aol.com: "Re: NEJM TERMPROM" In a message dated 96-04-26 08:10:10 EDT, R. Daniel Braun writes: >Several years ago, there was an article in NEJM (I think) showing an >increase in the section rate with induction for PROM as opposed to >"Expectant Management" even at term. All the womens groups got hold >of this. There was tremendous publicity about uncaring obstetricins who >wanted to increase their income inducing all patients with ruptured >membranes. Mother Jones also picked this up. Much HOOPLA resulted. I >also seem to remember 1 or 2 other studies that also showed an >increase in section rate in the induced group, but I don't have references >now. I attended a presentation at the 1994 UCSF Intrapartum and Antepartum Management Conference which included a literature review and concluded that the risk of C/S was increased with induction for term PROM (in primips only, no difference in multips) and that infection rate was equal in induced and expectantly managed groups as long as prophylactic antibiotics were begun at 18 hours after rupture. Tekoa King, CNM was the presenter. My syllabus, which includes the references, is at work in my locker, so I can't cite them at this time. Prior to my attendance at this conference the routine at my institution was induction 12 hours after SROM. We have since changed this policy. If women choose to be managed expectantly they are scanned for position and the presence of at least one 2 cm. pocket of amniotic fluid and sent home with po antibiotics. They return to L&D once each day for an NST. They are given printed instructions and take their temperatures at home. We will wait 48-72 hours after SROM, then begin induction (by prostin or pitocin depending on cervical ripeness). We have been following this protocol for about 1 1/2 years now, with very positive results. The women like it. We have not done an official study, but the general perception is that we see fewer fevers in labor and have fewer failed inductions. Cheri Van Hoover, CNM Kaiser Hospital Redwood City, CA Next message: dahmd@gate.net: "Re: HPV" Previous message: Anna Nickels: "Inductions, macrosomia, and a question" Maybe in reply to: Geff Klein: "NEJM TERMPROM" Next in thread: DoctorJoe@aol.com: "Re: NEJM TERMPROM"

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