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FOI REF: 20/173A 12 May 2020 FREEDOM of INFORMATION ACT

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FOI REF: 20/173A 12 May 2020 FREEDOM of INFORMATION ACT FOI REF: 20/173a 12 May 2020 FREEDOM OF INFORMATION ACT I am responding to your request for information under the Freedom of Information Act. The answers to your specific questions are as follows: 1. Clinical guidance for use of the Actim PROM test in force as of May 2011? We confirm we did not start testing for Actim PROM until 2013 therefore we do not hold this information. 2. Clinical Guidelines for the management of women with ruptured membranes before and after 37 weeks gestation as in force in May 2011? Please see attached document. Further to our response of 3rd April, we subsequently received the following request from yourself and our reply is detailed below: The policy you kindly disclosed (attached) relates to the Pre-Labour Rupture of Membranes after 37 weeks gestation only. Please can you confirm whether there was a policy in force during May 2011 which related to PROM before 37 weeks gestation? If so, I would be grateful if you could please forward me a copy of this for my records. Please see the attached clinical guidelines, section 5.6.2 PPROM (Preterm Prelabour rupture of membranes). If I can be of any further assistance, please do not hesitate to contact me. Cont…/ Should you be dissatisfied with the Trust’s response to your request, please write to Lynette Wells, Director of Corporate Affairs, East Sussex Healthcare NHS Trust ([email protected]) quoting the above reference. Yours sincerely Linda Thornhill (Mrs) Corporate Governance Manager [email protected] CLINICAL GUIDANCE NOTES 2.3 PRE-LABOUR RUPTURE OF MEMBRANES AFTER 37 WEEKS GESTATION (PROM). Written/Produced By: Title/Directorate Date: Nicky Mason Senior Midwife Practice Development April 2004 Anne Heseltine Lecturer Practitioner Senior Midwife Clinical Risk Mr D Pascall Consultant obstetrician 2008 Person Responsible for Chair of the Guideline Implementation Group for Monitoring Compliance & Maternity Services Review Signature & Date Multi-disciplinary Evaluation/Approval Name Title/Speciality Date: Professional Midwifery Forum Sept 2004 Obstetric and Gynaecology Oct 2004 Directorate Guidelines Group Maternity August 2008 Ratification Committee Issue Date of Next Date Name of Committee/Board/Group Number Issue & Review Ratified (Administrative Version Date use only) 2004111 October October 22/10/04 Clinical Governance & Risk Management 2004 v1 2007 Committee 2008274 Nov August 10/11/08 Clinical Governance Committee 2008 V2 2011 2.3 PRE-LABOUR RUPTURE OF MEMBRANES AFTER 37 WEEKS GESTATION (PROM). 1. Relevant to: 1.1 This guidance applies to all maternity staff. 2. Purpose of Guidance: 2.1 This document provides guidance on how to care for women with pre-labour rupture of membranes. 3. Refer to: 3.1.1 2.6 Use and Interpretation of Electronic Fetal Monitoring (CTG) Including Fetal Blood Sampling 3.1.2 2.8 Induction of Labour & Dose Regime for Syntocinon infusion for women undergoing induction of labour 3.1.3 5.3 Meconium stained liquor in labour 3.1.4 Perinatal guidelines for prevention and management of Group B streptococcal disease (GBSD) 3.1.5 Patient Information Leaflet from Intranet. ‘Information for Women’, ‘If your waters break before labour starts (PROM)’. 4. Process to Follow: 4.1 Introduction 4.1.1 Pre labour rupture of membranes is defined as Spontaneous rupture of membranes after 37 weeks gestation in the absence of regular contractions. 4.2 Principles 4.2.1 60% of women will go into spontaneous labour within 24hrs after rupturing their membranes 4.2.2 The risks of infection in mother and baby increases when the duration between the rupture of the membranes and the onset of labour is more than 24 hours. Planning birth within a specified time frame will increase the probability of a healthier outcome. 4.2.3 It is recommended that expectant management of labour should not exceed 96 hours as there is no evidence on outcome longer than this duration 2.3 Pre-labour Rupture of Membranes after 37 Weeks Gestation (PROM) Page 2 of 7 4.2.4 It is recommended that women who have had pre-labour rupture of membranes for greater than 24 hours are offered antibiotic therapy when they are in labour 4.2.5 Women with known or suspected Group B streptococcal infection may have greater risks associated with expectant management and their care should be planned on an individual basis. Immediate induction of labour should be considered 4.3 Determining spontaneous rupture of membranes: 4.3.1 It may not be possible to establish or confirm the diagnosis with any degree of confidence if the possible rupture of membranes has occurred some hours previously, as most of the fluid may no longer be in the vagina. 4.3.2 In these circumstances confirmation will depend on taking a careful history from the woman. This should include: When and how the gush of fluid occurred Whether anything has happened before, Approximately how much fluid was lost, What the colour was like, Whether it smelt of anything Whether there was any vernix seen 4.3.3 Following discussion with the woman, consent should be obtained to perform a sterile speculum examination and a high vaginal swab taken for microscopy (+/- Chlamydia). 4.3.4 Vaginal examination should be avoided in order to reduce the risk of intra- uterine infection. 4.3.5 Spontaneous rupture of membranes may be said to have occurred if: There has been a gush of fluid from the vagina and continued leaking There is a pool of fluid in the posterior fornix on speculum examination Oligohydramnios is found on ultrasound following a clear history of sudden release of fluid from the vagina. 4.3.6 Identifying when spontaneous rupture of membranes has occurred and documenting the time of occurrence is vital to the outcome of any of the care options. 4.4 Care following confirmation of Rupture of Membranes: 2.3 Pre-labour Rupture of Membranes after 37 Weeks Gestation (PROM) Page 3 of 7 4.4.1 Recent evidence (NICE) 4.4.2 “There is high-level evidence that shows an increase in neonatal infection when membranes rupture compared to intact membranes (1% vs 0.5%). This risk increases with the duration of membrane rupture. Expectant management up to 24 hours shows no evidence of a significant increase in neonatal infection rates.” 4.4.3 Comparison of the effects of planned early birth (immediate induction or induction within 24 hours) versus expectant management (no planned intervention within 24 hours. 4.4.4 There was no significant difference in neonatal infection (2.3% vs 2.9%), perinatal mortality or low apgar scores. 4.4.5 Women in the planned early birth group were less likely to develop endometritis or chorioamnionitis, although there was no significant difference between groups regarding postpartum fever. 4.4.6 There was no difference between groups regarding mode of birth 4.4.7 Care should be individualised according to the risks of infection, the risks of induction and the woman’s wishes. 4.5 The options for care are: 4.5.1 Options for care should be discussed with the woman and information given on: The risk of infection The use of antibiotics in labour Timing of induction of labour if labour does not start spontaneously within a given time frame 4.6 Expectant management 4.6.1 Women who are healthy and have had a normal pregnancy with no other contraindication at the time of confirmation of PROM may be offered Expectant Management to a maximum of 96 hours (see information leaflet) 4.6.2 As the time between the rupture of membranes and the onset of labour increases so do the risks of infection for the mother and baby. Induction of labour reduces these risks and expectant management should not exceed 4 days (96 hours). There is no evidence for expectant management greater than 96hours after membrane rupture. 4.6.3 N.B Induction of labour should be considered if a digital vaginal examination has been performed as this increases the risk of neonatal infection, 2.3 Pre-labour Rupture of Membranes after 37 Weeks Gestation (PROM) Page 4 of 7 4.6.4 Induction of labour 4.6.5 Women may be offered induction of labour at any time interval after PROM (0- 96 hours) 4.6.6 Induction of labour is appropriate after 24 hours 4.6.7 If spontaneous labour does not follow confirmation within the agreed time frame the mother will be admitted and offered induction of labour (see guideline 2.8 Induction of labour and 2.9 Syntocinon Regimen) 4.6.8 Women who present with any complications (mother or baby) should be referred to the on call Obstetric Registrar. 4.6.9 Once a decision has been made with regard to the care options, exact timing and planning for induction of labour should be organised on an individual basis to coincide with the time the woman ruptured her membranes and the staffing of the delivery suite. 4.6.10 For women who have PROM overnight this will mean adjusting the timing of induction either forwards or backward so that induction of labour with oxytocin can commence in the morning. 4.6.11 This planning of a proposed induction of labour should occur for all women, including those anticipating expectant management and subsequent spontaneous labour. 4.7 Antibiotic therapy 4.7.1 It is recommended that women who have had pre-labour rupture of membranes for greater than 18 hours are offered antibiotic therapy when they are in labour as prophylaxis for Group B strep – either: 4.7.2 Penicillin:G 3g intravenously initially and then 1.5g at 4 hourly intervals until delivery (If Penicillin allergic, use clindamycin 900mg intravenously every 8 hours until delivery) 4.7.3 Women with suspected chorioamnionitis should receive the following regime 4.7.4 When chorioamnionitis is suspected 4.7.5 Women who are febrile (temperature > 38 degrees C) and clinically suspected to have chorioamnionitis, should receive broad spectrum antibiotic therapy including an agent active against GBS and this will replace GBS-specific antibiotic prophylaxis.
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