|Not that kind of prom!|
Here are the cliff notes for PROM as it pertains to full-term labors:
- PROM is defined as the BOW breaking 1 hour prior to the start of contractions
- PROM is thought to affect 8-10% of all pregnancies
- 75% of women will spontaneously start labor within 24 hours after PROM
- 95% of of women with PROM will deliver within 28 hours
As noted, statistics do show that labor will likely start one way or the other within 24 hours, which means some women will start having regular contractions immediately while others will start at hour 23. The problem is no one knows which women will be the fast starters and who will be just getting going in the 23rd hour. In light of that range of variation, the differences in the managed care model of chemical induction and the watchful waiting model of the expectant care can be discussed.
There is a lot of research on PROM and as usual it is not a black and white issue. It is clear in the studies that most moms will shortly start labor on their own (within 24 hours) and various studies have compared the risk of infection between the watchful waiting approach vs the do something now approach. Most research states that there is little statistical difference in neonatal infection rates between the two groups, though there may be a slight increase in the risk of maternal infection in the expectant group. Infection rates in either group though are both low, under 1%. (Ironically one study states that despite infection rates being equal, more babies are actually sent to the NICU for observation after the expectant approach which probably indicates a bias assuming expectant care will lead to problems despite there being proof to the contrary)* C-section rates have also been compared and rates are found to be comparable in both groups of women.
|Amniosure, a test to|
confirm rupture of membranes
What does this mean for expecting couples? If your water breaks what should you do? These are great questions and expectant parents should preferably decide how they want to answer them before finding themselves leaking amniotic fluid. The answer will depend on the careprovider, the couple's attitude toward the research, the type of birth they are planning and even the ever present concern about rush hour traffic. If one experiences PROM and the decision is made to hang out at home, mom should eat/drink and try to get some rest. She can pay attention to her baby's movements, be aware if she starts to run a fever and follow her intuition. If it is chosen to go into the hospital mom should limit vaginal exams and discuss with her careproviders the risks of using pitocin to start labor vs the risks of waiting for labor to start. She can also consider low tech ways of bringing on labor such as nipple stimulation with a breast pump or walking.
*Abstract of this particular study: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005302.pub2/abstract