title: Labor analgesia for patients with preterm premature rupture of membranes.
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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Among women with PPROM, 63% delivered within 24 h from their second request for analgesia and 98% delivered within 48 h.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nursing, Labor and Delivery, Christiana Care Health Services, Newark, DE 19734, USA. mchichester@christianacare.org
authors.forename: M L
authors.initials: ML
authors.lastname: Chichester
authors.forename: M K
authors.initials: MK
authors.lastname: Hoffman
authors.forename: G H C
authors.initials: GH
authors.lastname: Colmorgen
authors.forename: P A
authors.initials: PA
authors.lastname: Shlossman
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D000767:Anesthesia, Epidural; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007745:Labor Onset; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors