There are two valid evidence based birth options for most women:
- Induction (active management) at term PROM or
- Waiting for labor to begin on its own (expectant management) after term PROM.
Induction with Pitocin (intravenous artificial oxytocin) as well as induction with a prostaglandin gel, AND expectant management all result in similar rates of neonatal infection and Cesarean Section.
The data from the term PROM studies show a neonatal infection rate that ranged from 2-3%. Neonatal is classified as ≤28 days. There was no difference in newborn infection rates between any of the study groups.
The best I could find for today’s rate was (on numerous online websites) that intrapartum (during labor) fever affected moms and babies in 1-2% of all deliveries and of those chorioamnionitis accounted for 2-4% of these incidences. These numbers are from 2017 and are for all births whether or not PROM was present, and what they meant by chorioamnionitis is not specified.
There exists a serious amount of lag time in medicine. It can take upwards of 20 years for research findings to be translated into routine clinical procedures. NON-evidence based care happens all the time in birthing situations, unfortunately, I find myself having to write about this frequently but I believe it is important to know now rather than after the fact so that you can better assure for yourself optimal maternity care.
As they say on Evidence Based Birth: Practice that is not based on the best evidence is not best practice.
The dance you will be sharing with PROM (hee hee) is a mash up of non-evidence based care, active precautionary management, time management etc. I will leave the malpractice CYA tactics to another time.
The largest concern surrounding term PROM is that during prolonged PROM (≥24 hours in the absence of contractions) women and their babies face a higher risk of infection. So I guess the logical place to “start” is with the 24 hour clock rule.