Felicity
The quote was from the 'Term PROM' study, the largest mullticentre trial of
care for women with pre-labour rupture of membranes (PROM) at term. RWH
Brisbane was one of the participating Australian Hospitals. It was
published early in 1996 I think, and I dont have the reference here at
home, but will locate it for you.
And yes, it did find that the majority of women were happy to have labour
induced (syntocinon or Prostin - 2 armsof the trial) than wait for 3 days
to see if labour occured spontaneously (After 3 days those not in labour
were induced by the methods previously mentioned - groups 3 and 4).
However, there was NO STATISTICALLY SIGNIFICANT difference in outcomes, eg
infection, perinatal morbidity/ mortality etc between the early
intervention and wait up to 3 days, groups.
The conclusions were that provided there were no signs of
infection/impending infection it was fine for women to choose either
immediate induction or waiting for a few days, though the women who were
induced early were more happy with their treatment than those randomised to
the delay groups. I feel using the quoted statement as information for
women who MAY experience term PROM some time in the future, is misleading
in that it gives only one selective view of the study and is a subtle form
of coersion, to ensure that women follow the preferred course of action of
a particular hospital should they be unfortunate enough to have PROM at
term. While it may be true that most woment prefer induction to delay (and
that's fine), these women are not being provided with the information to
enable informed choice.
Some women may feel strongly about waiting, providing mother and baby
remain healthy, and that is their right. If they choose this option they
should not be made to feel guilty, nor should they be pressured with scare
tactics. Informed choice means that all the possibilities are presented..
Marie Barton
<[EMAIL PROTECTED]>
> To: [EMAIL PROTECTED]
> Subject: Re: Evidence based info
> Date: Sunday, 8 August 1999 10:37
>
> Hi all,
>
> I am most intrigued by this statement:
> "...in a large recent study more women were satisfied with their care
when
> labour was induced with intravenous oxytocin compared to a wait and see
> approach."
> Could somebody please direct me to the source/research?
>
> Many thanks,
> Felicity
>
>
>
>
>
> >> Heather we are also reviewing policies at the BC as a result of a
NHMRC
> >Evidence Based Clinical Practice Research Program . The Mater Mothers'
> >Hospital are overseeing this program they would be more than happy to
give
> >you some flow charts, guidelines and information sheets for Women to
read
> >I'm sure.
> >>
> >> We like to provide Families with research based, accurate information
- if
> >it does not become a compulsory addition to your policy manual you might
> >like to have a look at the information from the MMH independently. For
an
> >example some quotes from the Families information sheet include
> >> One in every 10 women giving birth will have TermPROM.
> >> Research has shown that women with TermPROM who have labour induced
are
> >less likely to develop infection because they have shorter labours and
fewer
> >vaginal examinations during labour.
> >> ., in a large recent study more women were satisfied with their care
when
> >labour was induced with intravenous oxytocin compared to a wait and see
> >approach..
> >>
> >> mmmmmmmm if "one third of Women are GBS+", "1 in 1000 babies are
> >affected ", 'usual' SROM is whilst labouring and "Approximately 20% of
men
> >and nonpregnant women with GBS disease die of the
> >disease"...............................mmmmmmmmmm
> >>
> >> Heather in response to your request Anne Eaton the Womens Health Unit
CNC
> >has this week competed the new policy for prophylaxis prevention of GBS
> >infection I am sure she would be available to discuss your requests if
you
> >wanted to contact her. If you would like a copy I could send it to you.
> >And lastly, when we as a team complete our policy for the BC I could
also
> >send you a copy.
> >>
> >> Some recommendations from the WHU policy
> >> No routine A/N screening
> >> Recommended I/P A/B <k35
> >> ROM >18hrs
> >> M temp _>
> >> GBS colonisation ever detected
> >> GBS bacteriuria " "
> >> Previous infant GBS+
> >> Rx M
> >> IV penicillin 1.2g 4h for duration of labour or
> >> Erythromycin if allergy 500mg 6h for duration of labour
> >> *Aim at least one dose of A/B 4h prior to birth, however 2h will give
baby
> >adequate cover. Neonatal staff to be informed of m temp_> 38 in first
24 h
> >> Maternal Anaphylaxis Rx...........
> >> Rx B
> >> Urine spec
> >> Gast asp
> >> 1h obs for 4h then 4hrly until 24h old (cease if urine neg)
> >> *If rec A/B not given or A/B <2h Rx penicillin imi 50mg/kg single if
> >infection thought likely cont until culture results avail
> >>
> >>
> >> Cheers
> >> Katrina
> >>
> >> --
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> >>
> >
> >--
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> >
> ______________________________________________________________
> "Never doubt that a small group of thoughtful, committed citizens can
> change the world. Indeed it is the only thing that ever has"
> Margaret Mead
>
>
> _--_|\,-- From Townsville ** Felicity Croker
> / \ in sunny ** Psychology & Sociology &
> \_.--._/ North Queensland ** Centre for Women's Studies
> v ** James Cook University
> ** TOWNSVILLE, QUEENSLAND 4811
> AUSTRALIA
>
> PH: (07) 4781 4909
> INTERNATIONAL: 61747814909
> FAX: 61 7 4781 5117
>
>
>
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