PROM - does anyone's hospital suggest waiting 96 hours before induction?

[nappyaddict]

NICE guidlines say they should offer you monitoring for up to 96 hours before offering induction but most hospitals I know gently insist on induction after about 48 hours.

My waters went early Wednesday morning and I was told I would have to be induced on the Friday evening because of the risk of infection. At the time I didn't know about NICE guidelines and I wish I'd held off and waited to see if he came naturally because I really would have liked to use the birthing pool.

If they are leaving you that long with premature rupture (i personally would not want that), ask to be swabbed for infection.

Guidelines are 24hrs now. When I had dd 3yrs ago I was given 24hrs. There's good evidence to suggest it's much safer than the old guidelines of 96 hours. You don't HAVE to do anything though.

Yes, someone- maybe you Loopy, flagged this in another thread, and I'm really glad as I've been quizzing my IM's about it since (slightly obsessed that it will all happen to me again).

Laughingly the guidelines have changed from 96 to fall into line with NHS guidelines, that are stuck to by most units.

BUT...
It is interesting to note that the medical research upon which these particular NICE guidelines are based has not changed and still indicates beyond 96 of RM as being the time most likely to be at risk from infection.

AND...
Even if you took 96 hours and still no established labour (me, me, me!), you can test yourself for infection and if at any point you require it, can take antibiotics and still go into labour naturally in own time.

Many apologies if completely off topic here! Didn't mean to write so much at all!

Ah interesting Showofhands, I've quizzed several midwives now about this and none were aware of an actual body of evidence that suggests 24hours as being notably safer than 96.

And NICE have not based their change in opinion on any new submissions of research as far as I'm aware. Do you think this was maybe NHS stats instead?

Slightly obsessed for info on the subject!

I have all the stuff somewhere from the change of guidelines (had a PROM with dd and the obs cons printed it all off as part of my debrief). But we've moved house and it's all in boxes. I just remember that I read it and was happy with the logic. Labour started anyway so it was irrelevant to me in the end.

I had PROM at 36wks with DS1 (3 yrs ago). They let me go 7 days before induction, bascially inducing me on the dot of 37 wks to avoid him being premature. BUT I did have to have daily monitoring, which entailed me taking my temp. twice daily, daily visit to the hospital (monitored heartbeat, checked temp again, tested wee) PLUS I had to take oral antibiotics.

In labour I also had to have 3 lots of IV antibiotics. My son was fine (as was I).

Interestingly, I didn't ask for this (I was pretty clueles, not to mention shocked at the PROM) but it was good as by the time I went in for the induction I was 3cm dilated and thus induction was very straightforward with no other intervention. Had I been induced 24 hours (or even 96 hrs) later it would have been a different story, as my body just wasn't ready.

BUT even now I'm not sure about the risk. I have 2 friends whose waters broke early (undetected). One baby was OK (in hospital for 3 days) but sadly one died a few mins after birth. So the risk of infection shouldn't be underestimated.

Don't know if that helps at all!!

Beertricks, what gestation did you PROM at though??

My experience is different to those above as I pPROM'd at 14 weeks and management at that gestation is obviously different.

However, having got a serious infection, which showed absolutely no symptoms at all until the morning I went into labour (despite thrice weekly blood tests and in the end in patient hospital monitoring, so blood pressure, pulse, temp etc being taken regularly) if I got PROM near term I would be more than happy to be induced. As far as I am aware, outcomes for babies where there is infection in the uterus is not good and my consultant told me choriamnionitis is a significant cause of maternal death.

I had a hindwater rupture at 34 weeks, stayed in hospital for 5 days, then spent 3 nights at home, taking temp and antibiotics etc. When I went in for blood tests and monitoring (it was intended I reach 36 weeks) I was feeling decidedly not so great so they induced me and had IV antibiotics. Baby was fine with apgars of 10 and 10 at 35w5d.

Remember SouthseaRocks over on the pregnancy forum hung on for 6 weeks I think and they induced at 34 weeks as it was the balance between risk to the baby from being inside versus being outside at that gestation.

So I can kind of see why they would have a shorter period of time post term when the benefits outweigh the risks given the baby is almost certainly ready. Although of course there are the risks associated with induction.