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Management of PRELABOUR RUPTURE of MEMBRANES at Term May 2014 CLINICAL PRACTICE GUIDELINE NO.13 Management of Prelabour Rupture of Membranes at Term

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Management of PRELABOUR RUPTURE of MEMBRANES at Term May 2014 CLINICAL PRACTICE GUIDELINE NO.13 Management of Prelabour Rupture of Membranes at Term CLINICAL PRACTICE GUIDELINE13 Management of PRELABOUR RUPTURE OF MEMBRANES at term May 2014 CLINICAL PRACTICE GUIDELINE NO.13 Management of prelabour rupture of Membranes at term AUTHORS CONTRIBUTORS Tasha MacDonald, RM, MHSc Suzannah Bennett, MHSc Kathleen Saurette, RM Cindy Hutchinson, MSc Bobbi Soderstrom, RM CONTRIBUTORS ACKNOWLEDGEMENTS PROM CPG Working Group Megan Bobier, BA Clinical Practice Guideline Subcommittee Ontario Ministry of Health and Long-term Care Teresa Bandrowska, RM Ryerson University Midwifery Education Program Cheryllee Bourgeois, RM Elizabeth Darling, RM , MSc The Association of Ontario Midwives respectfully Corinne Hare, RM acknowledges the financial support of the Ministry of Sandy Knight, RM Health and Long-Term Care in the development of this Jenni Huntly, RM guideline. Paula Salehi, RM The views expressed in this guideline are strictly those Lynlee Spencer, RM of the Association of Ontario Midwives. No official Vicki Van Wagner, RM, PhD (c) endorsement by the Ministry of Health and Long-Term Rhea Wilson, RM Care is intended or should be inferred. Insurance and Risk Management Program ‘Remi Ejiwunmi, RM, Chair Abigail Corbin, RM Elana Johnston, RM Lisa M Weston, RM This document may be cited as: PROM CPG Working Group. Association of Ontario Midwives. Management of Prelabour Rupture of Membranes at Term. July 2010. This guideline was approved by the AOM Board of Directors: July 5, 2010 Management of PRELABOUR RUPTURE OF MEMBRANES at term Statement of purpose Methods The goal is to provide an evidence-based clinical practice A search of the Medline database and Cochrane library guideline (CPG) that is consistent with the midwifery from 1994-2009 was conducted using the key words: philosophy of care. Midwives are encouraged to use this prelabour or preterm rupture of membranes, pregnancy CPG as a tool in clinical decision-making. and management. Additional search terms were used to provide more detail on individual topics as they related Objectives to term PROM. Older studies were accessed in cases of The objective of this CPG is to provide a critical review of seminal research studies, commonly cited sources for the research literature on the management of prelabour incidence rates, or significant impact on clinical practice. rupture of membranes (PROM) at term gestation. Appendix 1 provides further guidance to midwives Evidence relating to the following will be discussed: and clients on the interpretation of GRADE • Impact of PROM on maternal and neonatal recommendations. A full description of the AOM’s outcomes policy and procedure for guideline development using • Diagnosis and assessment of PROM GRADE can be provided on request. • Management options for PROM Review: Outcomes of interest This CPG was reviewed using a modified version of the 1. Maternal outcomes: infection rates, mode of AGREE instrument (1), the Values-Based Approach delivery, satisfaction with care to CPG Development (2), as well as consensus of the 2. Neonatal outcomes: perinatal morbidity, perinatal PROM Working Group, the CPG Subcommittee, the mortality Insurance and Risk Management Program and the Board of Directors. This guideline reflects information consistent with the best evidence available as of the date issued and is subject to change. The information in this guideline is not intended to dictate a course of action, but inform clinical decision making. Local standards may cause practices to diverge from the suggestions within this guideline. If practice groups develop practice group protocols that depart from a guideline, it is advisable to document the rationale for the departure. Midwives recognize that client expectations, preferences and interests are an essential component in clinical decision making. Clients may choose a course of action that may differ from the recommendations in this guideline, within the context of informed choice. When clients choose a course of action that diverges from a clinical practice guideline and/or practice group protocol this should be well documented in their charts. Management of Prelabour Rupture of Membranes at Term 3 Abbreviations BMI body mass index EOGBSD early-onset group B streptococcus disease IAP intrapartum antibiotic prophylaxis MSAF meconium-stained amniotic fluid NICU neonatal intensive care unit OR odds ratio PROM prelabour rupture of membranes PPROM preterm prelabour rupture of membranes RCT randomized controlled trial ROM rupture of membranes RR relative risk SROM spontaneous rupture of membranes KEY TO EVIDENCE STATEMENTS AND GRADING OF RECOMMENDATIONS, FROM THE CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE Evaluation of evidence criteria Classification of recommendations criteria I Evidence obtained from at least one A There is good evidence to recommend the properly randomized controlled trial clinical preventive action II-1 Evidence from well-designed controlled B There is fair evidence to recommend the trials without randomization clinical preventive action II-2 Evidence from well-designed cohort C The existing evidence is conflicting and (prospective or retrospective) or case- does not allow to make a recommendation control studies, preferably from more than for or against use of the clinical preventive one centre or research group action; however, other factors may influence decision-making II-3 Evidence obtained from comparisons C The existing evidence is conflicting and between times or places with or without does not allow to make a recommendation the intervention. Dramatic results in for or against use of the clinical preventive uncontrolled experiments (such as the action; however, other factors may influence results of treatment with penicillin in decision-making the 1940s) could also be included in this category III Opinions of respected authorities, based D There is fair evidence to recommend on clinical experience, descriptive studies, against the clinical preventive action or reports of expert committees E There is good evidence to recommend against the clinical preventive action L There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making Reference: (3) 4 AOM Clinical Practice Guideline 13 INTRODUCTION Prelabour rupture of membranes (PROM) is a common PROM do not begin labour within 7 days of membrane variant of normal in term pregnancy. Despite the rupture. (6) rarity of major complications, PROM is associated with increased maternal and neonatal morbidity. Etiology Disagreement exists among maternal health care The etiology of PROM is poorly understood. Most providers on the optimal management of women research investigating the causes of PROM has focused with PROM, particularly the need for and timing of on PPROM or has failed to differentiate between inductions. Midwives providing care for women with PPROM and PROM. Researchers have hypothesized PROM aim to avoid unnecessary interventions while that PPROM and PROM are products of different facilitating the best outcomes possible for mothers and mechanisms, speculating that PPROM is associated babies. The midwifery management of PROM includes: with pathological mechanisms such as infection, while diagnosing PROM; assessing fetal and maternal well- PROM may simply be a variation of normal parturition. being, and determining the need for and timing of (9) More recent research suggests that PROM may induction. be a result of a “programmed weakening process” in which the membranes weaken prior to labour. (10) Definition and Terms Other proposed mechanisms for PROM include PROM is defined as the rupture of membranes before the membranes being weakened by mechanical forces, such onset of regular uterine contractions at term gestation as polyhydramnios or multiple gestation. (11) Small ( ≥ 37+0 weeks’ gestation). In the research literature, case-control studies investigating the etiology of both PROM has also been referred to as “premature rupture PPROM and PROM have repeatedly found that PROM of the membranes,” causing considerable confusion at different gestations appears to have different origins. as this term also implies neonatal prematurity. In this (12-14) It has been surmised that women with PROM document, PROM < 37 weeks gestation is referred who do not go into spontaneous labour after a long latent to as “preterm prelabour rupture of the membranes” period may have deficient prostaglandin production or (PPROM). The “latent period” is the interval between prostanoid biosynthesis pathways. (15) membrane rupture and the onset of active labour. Expectant management, sometimes referred to as Associated Factors “conservative management,” involves waiting for women An American cohort of more than 5000 women in to begin labour spontaneously. A policy of induction, 12 different sites found that a history of PROM was or “planned management,” or sometimes referred to as the strongest predictor of PROM in the subsequent “active management,” involves inducing women with pregnancy. This study examined the risk factors PROM within a short period of time from membrane for PROM in women with two successive singleton rupture. pregnancies, in an attempt to control for genetic factors. Twenty-six percent of women who experienced PROM Prevalence in their second pregnancy had PROM in their previous PROM occurs in approximately 10% of all pregnancies pregnancy. When the first pregnancy went to term (ranging from 2.7% to 17%), with 60% to 80% of cases without PROM, only 17% of the subsequent pregnancies occurring at term. (4) The Niday
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