How long to wait?

There are a lot of other variables (gestational age, cervical ripeness, time of day to name just three) but in a term pregnancy with everything being normal, most of our docs will wait 12 hours to start Pit.

If all is well (term, GBS negative, etc.) we book an induction and get them in within 24 hours of the SRM.

Has anyone had a pt. refuse intervention and have a good outcome. I had a pt who had been srom for 17 hours and still refusing interventions when I left. I haven't had anyone do that yet.

With expectant management of ROM 96 hours is reasonable to wait. We do most of ours round 24; some wait longer. The risks to the baby are minute really when you look at the big picture. What often causes problems are the multiple VEs that go along with the oxytocic induction! Will post some references later.

some relevant papers and stuff. the hannah trial is the one that everyone uses, but is rather old now!

http://content.nejm.org/cgi/content/full/334/16/1005

http://www.radmid.demon.co.uk/prom.htm

http://www.ranzcog.edu.au/publications/o-g_pdfs/o&g-summer-2006/managing%20prom%20and%20pprom%20-%20emma%20parry.pdf

http://www.medscape.com/viewarticle/494127

great paper is you can get your hands on it.

j midwifery womens health. 2007 may-jun;52(3):199-206

midwifery management of prelabor rupture of membranes at term.

marowitz a, jordan r.

frontier school of midwifery and family nursing, hyden, ky, usa. [email protected]

spontaneous rupture of membranes before the onset of labor at term is commonly referred to as prom (either premature or preterm rupture of membranes) and occurs in about 8% of term pregnancies. prom is associated with an increased risk of infection. many controversies exist regarding the optimal management of prom, including the choice of induction or expectant management, use of digital lady partsl exams, and routine administration of antibiotics. this article reviews the literature on prom and illustrates some of the management issues encountered by presenting approaches used in three midwifery services.

pmid: 17467586 [pubmed - indexed for medline]

Depends here too as the pp said, gest age, sometimes gbs status, what they are already dilated to, if they are a multip etc...

Unfortunately here we go more by the docs schedule... If someone comes in at 9pm for example we usually just sleep them til the am, if they come in at 9am our docs are quick to start it right away. I'm actually amazed that more women don't refuse.

I've seen many women refuse intervention and go on to have happy, healthy babies. Remember, pregnancy and birth are normal, healthy events. Most of the time medical management is not needed. That being said, I've also seen women get raging chorioamnionitis and be very sick and have very sick infants. One of the best things to remember is to KEEP YOUR FINGERS OUT OF THERE!!!!!

Steril spec exam - no digital - home back if not in labour by 24 hours - Evidence showesthat 80% will go in to labour on their own within this time.

Our docs vary in what they do. It also depends on the things that others have already listed. I have seen a doc let a term, gbs- pt gp 3 days but she started antibiotics after 24 hours and let us do the pit really slow. We had it on for a while then rest at night then back on in am. I had her all three nights and she got to about 4cm at 5am and delivered at 8. She was also a prime.

My personal experience was that I was a g6p3 with pg#1 PCS pg#2 RCS pg #3 VBAC. I prom at 37weeks, gbs-, hx of large babies. I had midwives and I was previously 2cm/50/-2 on monday and prom on wednesday 1pm. I went in and my midwife said that she wouldnt check me b/c she already knew where I was 2 days ago and she let me go home. I slept all night and she called in the am. I hadnt had one single ctx (ironic given that I had been in preterm labor 3 weeks prior). I cam in at 11am on Thursday started pit at 2mu and delivered at 7:59pm with one push. Healthy baby and healthy mom. I wasnt a nurse back then and now that I am, I am glad that she didnt start "checking" me and gave me a chance before intervention.