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Audit on the management of ruptured membranes at term
  1. S Manjambigai,
  2. H Sawhney,
  3. R Nagrani
  1. ABM University LHB, Swansea, UK

Abstract

Aim The National Institute for Health and Clinical Excellence (NICE) guidelines advocate induction of labour (IOL) with Syntocinon infusion after 24 h of spontaneous rupture of membranes (SROM) at term and avoidance of digital examination. Based on this guideline, we audited our practice of IOL and also audited the documentation of discussion with patients about duration and pain relief in labour if induction was accepted.

Method Retrospective review of case notes over a 6 month period.

Results 42 notes were reviewed. 23 women were offered IOL after 24 h of SROM. The time range of Syntocinon infusion was 8 to 24 h (14 women for 8 h, 6 for 12 h and 3 for 24 h). 17 women had vaginal delivery, 4 had assisted vaginal delivery and 2 had emergency caesarean section. Maternal and fetal complications were low. The remaining 19 women with SROM were thought to be in spontaneous labour following digital examinations. They took up to 48 h to go into active phase of labour. The duration of labour lasted up to 24 h in 9 women. Only 6 women had normal vaginal delivery in this group while 9 had LSCS and 4 instrumental delivery.

10 women who required augmentation with Syntocinon for slow progress had more intervention rates and higher complications.

Conclusion IOL soon after SROM improves outcome and does not increase intervention. In spontaneously labouring women, delay in augmentation leads to intervention with poorer outcome.

Recommendation Adhere to NICE guidance of prompt IOL, avoidance of digital examination and good documentation.

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