Abstract
Objective:
Cervical examination is relatively contraindicated in women with preterm premature rupture of membranes (PPROM), limiting our ability to determine the onset of labor by traditional definition (contractions with cervical change). We sought to determine whether two maternal requests for analgesia within 3 h predicted delivery within 24 h to allow appropriate epidural placement.
Study design:
We performed a retrospective chart review of all patients with PPROM for a period of 18 months. Our primary outcome was the percentage of women with PPROM (<34 weeks) who delivered within 24 h from the second analgesia request.
Result:
Among women with PPROM, 63% delivered within 24 h from their second request for analgesia and 98% delivered within 48 h.
Conclusion:
Two medication requests within 3 h for regular, painful contractions can be used as an indicator of onset of labor in women with PPROM to allow for labor analgesia.
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References
ACOG Committee on Obstetric Practice. ACOG Committee Opinion number 269: analgesia and cesarean delivery rates. Obstet Gynecol 2002; 99: 369–370.
Cunningham FG, Hauth JC, Leveno KJ, Gilstrap L, Bloom SL, Wenstrom KD . Normal labor and delivery. Rouse D, Rainey B, Spong C, Wendel Jr. GD (eds). Williams Obstetrics (22nd edn.) McGraw-Hill: New York, 2005, pp 409–442.
Eltzschig HK, Lieberman ES, Camann WR . Medical progress: regional anesthesia and analgesia for labor and delivery. N Engl J Med 2003; 348: 319–332.
Bailit JL, Dierker L, Blanchard MH, Mercer BM . Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstet Gynecol 2005; 105: 77–79.
Mercer BM . Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32: 411–428.
Pates JA, McIntire DD, Leveno KJ . Uterine contractions preceding labor. Obstet Gynecol 2007; 110: 566–569.
ACOG Committee on Obstetric Practice. ACOG Practice Bulletin Number 80: premature rupture of membranes. Obstet Gynecol 2007; 109: 1007–1019.
Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol 1993; 169: 851–858.
Alexander JM, Lucas MJ, Ramin SM, McIntire DD, Leveno KJ . The course of labor with and without epidural analgesia. Am J Obstet Gynecol 1998; 178: 516–520.
Sharma SK, Alexander JM, Messick G, Bloom SL, McIntire DD, Wiley J et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology 2002; 96: 546–551.
Leighton BL, Halpern SH . Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Semin Perinatol 2002; 26: 122–135.
Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005; 352: 655–665.
Cameron CM, Scott DA, McDonald WM, Davies MJ . A review of neuraxial epidural morbidity. Anesthesiology 2007; 106: 997–1002.
Dawson SJ . Epidural catheter infections. J Hosp Infect 20001; 47: 3–8.
Bricker L, Lavender T . Parenteral opiods for labor pain relief: a systematic review. Am J Obstet Gynecol 2002; 186: S94–S109.
Cesario SK . Reevaluation of Friedman's labor curve: a pilot study. J Obstet Gynecol Neonatal Nurs 2004; 33: 713–722.
Kilpatrick S, Garrison E . Normal labor and delivery. In: Gabbe SG, Niebyl SR, Simpson JL (eds). Obstetrics: Normal and Problem Pregnancies 5th edn. Churchill Livingstone: Philadelphia, 2007, pp 303–321.
Albers LL, Schiff M, Gorwoda JG . The length of active labor in normal pregnancies. Obstet Gynecol 1996; 87: 355–359.
Zhang J, Troendle JF, Yancey MK . Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol 2002; 187: 824–828.
Hoffman MK, Vahratian A, Sciscione AC, Troendle JF, Zhang J . Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol 2006; 107: 1029–1034.
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Chichester, M., Hoffman, M., Colmorgen, G. et al. Labor analgesia for patients with preterm premature rupture of membranes. J Perinatol 30, 650–654 (2010). https://doi.org/10.1038/jp.2010.18
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DOI: https://doi.org/10.1038/jp.2010.18