Talk:Prelabor rupture of membranes

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Cmascoe, Nrnittur (article contribs).

---

Not a very good article. There are one or two factual inaccuracies.

---

I have learned that PROM means Prelabour Rupture Of Membranes, and that PPROM means Preterm Prelabour Rupture Of Membranes. The word "premature" is not a good word to use here because it opens up for various misunderstandings. The article should be rewritten without using "premature". The words Preterm and Prelabour are self-explanatory and makes it easier to understand what this is about. This means that the name of the whole article entry should be changed. Gbwi (talk) 18:30, 13 August 2010 (UTC) -- I fully agree: The title of the article should be "prelabor rupture of membranes". The search of "premature rupture of membranes" should be redirected to "prelabor rupture of membranes". Emisanle (talk) 6:30, 13 June 2011 (UTC)

---

The reference that supports the emotional state of fear as a risk factor is a letter. This letter reports the study published here: https://docs.google.com/View?id=dfxgmmxk_37gj9rt7dj Emisanle (talk) 6:30, 13 June 2011 (UTC)

---

I have started editing this article and over the next few weeks will be attempting to clean up some of the errors and ambiguity that has been previously mentioned on this talk page. I plan to reorganize and add updated information using Beckmann's Obstetrics and Gynecology, Williams Obsetetrics, and Current Diagnosis & Treatment textbooks as well as the updated ACOG practice bulletin, cochrane reviews and meta analyses. If anyone is watching this page, please let me know if you have any feedback or suggestions. Thanks. Dorafriedman (talk) 00:24, 7 November 2014 (UTC)

Peer review

Hi Dorafriedman. You've done a wonderful job restructuring the article to follow the Wiki Medicine Manual of Style more closely. I think there has obviously been a lot of great effort to make the language more accessible and simple, though I think sometimes this results in unnecessarily complex sentences. For example, the first line of the lead has over 60 words and 6 commas, and can be a bit difficult to follow. Since I think including definitions for more complicated terms or concepts can be helpful, perhaps it'd be helpful to break some of the longer sentences into two distinct sentences. It also seems to get a bit more medical jargon-y and technical towards the diagnosis/management sections, which tend to be heavily read sections other than the lead. I think you added some very meaningful references, including the Beckmann book, various ACOG practice bulletins, and Cochrane reviews. Perhaps I'm misreading, but it seems like some of these are cited multiple times, such as reference 1 and 11 referring to the same Obstetrics & Gynecology Practice bulletin 139, and Beckmann being referenced twice (I realize they are different years, but maybe using the most recent one would be more valuable, if that information is still there?). Overall I think you've really done a lot of improve the content of this article, and I'm sure everyone who will access this important article in the future appreciates it!

---

Whit here, I thought those were good points raised by the peer reviewer. Simplifying the first sentence and cleaning up the references would be useful. Do you think it is worth putting information in the lead that PROM is significant and that it is a reason to contact the people taking care of you during pregnancy? Overall I think this is a valuable article and will be much improved from the efforts of dorafriedman.Emwhitaker (talk) 19:18, 14 November 2014 (UTC)

---

Thanks for the feedback! I have gone through to try to simplify complex sentences. I agree that some of the pathophysiology and management becomes pretty detailed, but I have tried to subdivide so that readers can easily skip what they are not interested in. Does the outline make sense? any ideas on how to make it even more navigation friendly? There are two references to Beckman because only parts of the chapters on this topic were available online, but together the whole topic is covered. The 6th edition is still pretty recent and I think the information there is valid and agrees with ACOG and other texts. I have also attempted to clear up and expand the lead adding what I think is most important to know, but this is definitely a section that could use more input. Dorafriedman (talk) 18:17, 21 November 2014 (UTC)

---

WikiProject Medicine

For our WikiProject Medicine course, we suggest the following changes to this article The references provided for this article are mostly appropriate and reliable (textbooks and meta-analyses). Reference 8 links to a pharmaceutical company, which we will have to reevaluate and remove the citing text to be replaced with something from a more neutral source. Similarly, source 14 links to a primary study, which will be removed and the associated text replaced with material citing a meta-review or textbook. Source 15 links to an expert opinion, and associated text will be replaced as well. The last edits on this page were made 2 years ago by one contributor who has extensively added to the lead, risk factors, pathophysiology, and management sections. There does not appear to be paraphrasing or plagiarism. We did not feel like there was any type of bias towards any position, which is what we were especially assessing for in the management section. There may be too much included about PPROM in the lead, which should serve as a separate subsection of PROM, listed under the classification header. Otherwise, the lead is concise and provides an introductory level amount of detail to several of the following sections. The language used in signs and symptoms sounds subjective, and the information provided feels vague. N will restructure this section and include more signs and symptoms of PROM/PPROM as referenced in meta analyses found on PubMed, and statistics describing the incidence of each symptom should be included. Risk factors : Seems appropriate. Sources include several major ob/gyn texts. No edits to suggest Pathophysiology section: C will expand on genetics section. N and C will restructure weakened fetal membranes/infection section to integrate the idea that infection can lead to weakened fetal membranes and make this section more concise. Diagnosis: Remove the section under “extra tests” that directly referenced the pharmaceutical companies by name. (For N) Prevention: No edits to suggest Management: Review current literature for changes in management. Update sources and sections accordingly. C – PROM/Late preterm PROM . N – Early preterm PROM Consider removing chorioamnionitis section as information included here is mentioned in the outcomes section Outcomes: Change sentence referencing the vague “our test”, include references as appropriate. Outcomes for pre-term birth can be further delineated into early vs late preterm. (For C) Epidemiology: Review current data and update statistics as necessary. (For N)

We welcome any suggestions! Cmascoe (talk) 11:43, 27 October 2017 (UTC)

RfC On describing RCOG guidelines, should it include the curious insinuation that they are "not based on clinical evidence"?

On describing RCOG guidelines, should it include the curious insinuation that they are "not based on clinical evidence"? Boundarylayer (talk) 22:49, 1 November 2017 (UTC)

Background to RfC

Recently I removed the unsourced suggestion that the (RCOG)Royal College of Obstetricians and Gynaecologists guidelines referenced in this article, are to use the other editor's phrase : "based on expert opinion and not clinical evidence..." Here.

I removed this curious phrase, as what is this particularly unsourced statement suggesting? That the RCOG, are not following clinical evidence when making these guidelines? This seems to be a pretty extra-ordinary claim. WP:MEDASSESS gives great weight to "clinical guidelines". Especially such guidelines that have had zero reliable opinions ever describing them as "[not] based...on clinical evidence".

Rather than beginning a talk page discussion, as is the usual procedure. I considered it wiser to go directly towards a request for comment, considering the reply I received in relation to this matter. Here. With the editor who added this phrase, threatening to begin ban proceedings and other erroneous things, you can hopefully appreciate that a Rfc was considered the best port of call.

In regard to policy, if there is some existing policy to describe medically uncontroversial guidelines in this peculiar fashion, I would like to see precedence of it. As far as I can tell, guidelines are not supposed to be described in this bizarre fashion? I searched wikipedia and have not found another example of this phrase "based on expert opinion and not clinical evidence". Anywhere else.

Boundarylayer (talk) 22:49, 1 November 2017 (UTC)

The sentence in question is on page 7 in the report, where it says Attempting delivery in the setting of maternal instability increases the maternal and fetal mortality rates unless the source of infection is intrauterine. Directly to the right of this, the "evidence level" is given, which is 4.

In Appendix 4, on page 13, the evidence-based medicine levels are defined: I will copy/paste them here. Note that level 1 is highest and levels 1 through 3 involve actual evidence, while level 4 (the lowest) is simply "expert opinion."

Classification of evidence levels

• 1++ High-quality meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a very low risk of bias
• 1+ Well-conducted meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a low risk of bias
• 1– Meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a high risk of bias
• 2++ High-quality systematic reviews of case–control or cohort studies or high quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
• 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal
• 2- Case–control or cohort studies with a high risk of confounding, bias or chance and a significant risk that the relationship is not causal
• 3 Non-analytical studies, e.g. case reports, case series
• 4 Expert opinion

The edit is supported by the source. It appears that the OP does not understand that the "4" in the margin is meaningful, and has not read the appendix, and possibly does not understand how evidence-based medicine is deployed in clinical guidelines. Jytdog (talk) 03:18, 2 November 2017 (UTC)

The edit is not supported by the source, it would have been if you simply wrote "based on expert opinion". Instead you describe it as "based on expert opinion and not clinical evidence..." Which will naturally cause readers to wonder, is there a controversy over this, a suggestion that clinical evidence is being ignored etc? Your edit opens up a can of innuendoes. When "based on expert opinion" would've more than sufficed.

Again there is no precedence for this phrase "based on expert opinion and not clinical evidence..." anywhere else on wikipedia.

Boundarylayer (talk) 17:55, 2 November 2017 (UTC)

The edit is clearly supported by the source, and your objection is not competent. I am sorry to say that, as you are clearly passionate about this. Jytdog (talk) 18:01, 2 November 2017 (UTC)

Comment, Jytdog is clearly right on a factual level, however I agree with Boundarylayer that the phrase might easily be mis-understood by the general reader. Is there a way of rephrasing along the lines of "has not been corroborated/tested/similar by clinical trials"? Pincrete (talk) 19:59, 2 November 2017 (UTC)

Or simply rephrased to accurately communicate that "According to the RCOG guidelines of 2012, based on expert opinion, attempted delivery during maternal instability...etc" and leave it at that? As the mere suggestion that this "is not based on clinical evidence", or that it has not been rigorously tested and trialed just needlessly injects undue ambiguity. Indeed things like this will hopefully never be thoroughly tested by clinical trials, as to do so, would mean the death of mothers. It's therefore literally a total train-wreck of a suggestion, that generates absurdities.

Boundarylayer (talk) 20:17, 2 November 2017 (UTC)