Controversial issues in Midwifery Practice: Prelabor rupture of membranes - Essay Example

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Running head: THE ROLE OF THE MIDWIFE AND PRELABOUR RUPTURE OF MEMBRANES The Role of the Midwife and Prelabour Rupture of Membranes (37+weeks): Critical Analysis Abstract This paper analyses the literature on prelabour rupture of membranes for term pregnancies (37+ weeks)…
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Controversial issues in Midwifery Practice: Prelabor rupture of membranes
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Download file to see previous pages The Role of the Midwife and Prelabour Rupture of Membranes (37+weeks): Critical Analysis The premature rupture of membranes (PROM) at term is the rupture of the membranes before labour has commenced at any time after the 37th of gestation. It is estimated that PROM occurs in 10% of normal pregnancies (Hannah, Ohlsson, Farine et al. 1996). The symptoms include leakage of fluid, a vaginal discharge, bleeding from the vagina, and in some cases pressure on the pelvis. These symptoms are combined with the absence of contractions. Although there are a few tests to determine ROM there are some like any blood contamination of Nitrazine paper that can cause a false-positive result (Hannah, Ohlsson, Farine et al. 1996). The most effective determination of ROM is from an internal examination that finds the pooling of fluid in the vaginal cavity, or a leakage of fluids from the cervix. This internal examination can be confirmed with an ultrasound that will show the level of amniotic fluid in the uterus. Hannah (1998) found that PROM could be influenced through a distension of the uterus in women with multiple pregnancies, cigarette smoking, high levels of amniotic fluid, frequent digital examinations, coitus and infections although she noted that there was no certainty that any of these issues were actually a causal element in PROM. PROM has been implicated in immediate risks such as cord prolapse, cord compression and issues with the placenta as well as maternal infection, neonatal infection, increased caesarean sections and the use of instruments in a vaginal delivery (Alexander 1996, Merenstein 1996). Use of expectant management with PROM has been found to increase the incidences of chorioamnionitis or endometritis which in turn can result in neonatal infection, mortality, chronic lung disease and cerebral palsy (Dare et al. 2006). There is some evidence that suggest that there is an increased risk of infections for mother and baby as the time between PROM and the actual labour increases (Gafni 1997) but this has since been refuted by Hannah (1998) and Seaward (1997). Hannah (1999) determined that women appeared to be happy with the birth process and the standard of care if there was a short time between PROM and birth (c.f expectant management). In most cases women will go into labour by themselves within 24 hours of the ruptured membranes. In cases where contractions have not started within that time there is evidence that infections can occur. There are two schools of thought of what should happen in the case when contractions have not started. The first is that labour should be induced using drugs; the other opinion is that expectant management should be allowed to continue. This paper will look at the evidence supporting both sides of the debate before presenting a critical analysis and a discussion on the role of the midwife in this issue. Literature Review: Inducing Labour Most of the available literature on PROM was actually based on pregnancies that were less than term (37 weeks). That topic has its own set of issues and all of those studies were excluded from this review because the focus is on term pregnancies (37+ weeks). Hannah, Ohlsson, Farine et al. (1996) did one of the largest studies on more than 5000 women who had PROM. The women were randomly ...Download file to see next pagesRead More
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