Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

Abstract

Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB.

Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD).

Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge.

Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.