Evidence Based Medicine Re: Your Membranes Releasing Prior to Labor Beginning
What does this mean? The internet offers these definitions:
Definitions of Evidence-based medicine on the Web:
- Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).
- Heath care whose policies and practices are derived from the systematic, scientific study of the effectiveness of various treatments
- The practice of medicine or the use of healthcare interventions guided by or based on supportive scientific evidence. Also, the avoidance of those interventions shown by scientific evidence to be less efficacious or harmful.
- The practice of medicine with treatment recommendations that have their origin in objective tests of efficacy published in the scientific literature rather than anecdotal observations.
- An approach to practicing medicine that involves consideration of results of clinical trials that are relevant to the disease or condition being treated when making decisions about how to treat patients.
- is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. …
- For many in the medical field, evidence-based medicine includes only those treatments that have been shown to be effective through a narrow lens, especially double-blind studies. …
- Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise to aid in the diagnosis and management of patients.
- Before you decide to just go with the flow on what the practice of which you are a patient, ask yourself… is this just the way they do things?– the way they have always done things?– or are they staying current on what the studies actually show is proven? Interventions that are often suggested are often done because that is the way they have always been done– no matter if they are actually causing more harm than benefit.
86% of women will labor within 12-23 hours
91% will labor within 24-47 hours
94% will labor within 48-95 hours
6% of women will not be in spontaneous labor within 96 hours of PROM.
Most maternity units therefore practice what is called ‘expectant management’. The mother is asked to wait either at home or in the unit for 24-48 hours to ‘see what happens’, knowing that the majority of women will start to labor without any further intervention. During this time they will be asked to report back if the color of the fluid changes or they feel unwell.
After this time most units would encourage induction of labor as the longer the time interval of ruptured membranes, the higher the risk of infection.
In addition to this most maternity units also encourage antibiotics for prolonged rupture of membranes, after varying lengths of time, depending upon research evidence and local policies. These are usually given orally before labor and intravenously during labor, to reduce the risk of infection.
Some units also give the mother the choice of immediate induction of labor after SROM. Whilst this is done to reduce the risks of infection, it is important to acknowledge the risks of intervention and failed induction which could result in Caesarean section.”
Medscape states this: “Most patients (90%) enter spontaneous labor within 24 hours when they experience ROM at term. The major question regarding management of these patients is whether to allow them to enter labor spontaneously or to induce labor. In large part, the management of these patients depends on their desires; however, the major maternal risk at this gestational age is intrauterine infection. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate.4,5