Thursday, December 13, 2007

MDC disaster watch

Another potential tragedy is shaping up on the UC board on MDC. A woman with uncertain dates has had ruptured membranes for more than 48 hours, 2 vaginal exams and irregular contractions. She is posting for advice. She didn't ask me, but I'm going to offer some facts about prolonged ruptured membranes. They are not specific to her case, but they are factors that she should consider and that she probably doesn't know. Certainly no one on MDC is going to tell her because they don't know either. And of course, no one dares to mention that within the last few weeks an MDC member lost her baby to overwhelming infection after prolonged ruptured membranes.

A recent article in Obstetrics and Gynecology, Time Between Membrane Rupture and Delivery and Septicemia in Term Neonates reported on a study of rupture membranes in over 100,000 singleton term babies:
The rate of neonatal sepsis was 0.3% at a membrane rupture to delivery interval below 6 hours, 0.5% at 6–18 hours, 0.8% at 18–24 hours, and 1.1% after 24 hours. The risk of neonatal sepsis increased independently and nearly linearly with duration of membrane rupture up to 36 hours, with an odds ratio of 1.29 for each 6-hour increase in membrane rupture duration.
So the risk of a serious infection in this baby has already increased by 300% or more. Early neonatal sepsis can be sudden and catastrophic. The baby can be born looking fine and get become deathly ill within a few hours. That happened after a homebirth in Wyoming not too long ago. Alternatively, the baby can be born severely compromised. Or, the baby could simply die in utero.

This woman needs to go to the hospital and get induced, now. Yes, her chances of her dream birth will go down dramatically if she goes to the hospital, but her chances of a baby with a severe infection are rising with every hour that passes. Which is more important: her "experience" or the baby's health? Let's hope she makes the right decision.

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