Talk:Premature rupture of membranes

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commment 1[edit]

Not a very good article. There are one or two factual inaccuracies. — Preceding unsigned comment added by (talkcontribs) 11:03, 21 May 2007 (UTC)

comment 2[edit]

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)

comment 3[edit]

The reference that supports the emotional state of fear as a risk factor is a letter. This letter reports the study published here: Emisanle (talk) 6:30, 13 June 2011 (UTC)

comment 4[edit]

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[edit]

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! — Preceding unsigned comment added by Sho2014 (talkcontribs) 05:01, 14 November 2014 (UTC)

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[edit]

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)

Here's the first suggestion: use this talk page to make suggestions on how to improve the article (that's its purpose), not to do a review. We don't need to be told what doesn't need changing.
If you suggest a change, then please cite the source you're basing your opinion on. It would also be helpful if you give an idea of the text change you think would be an improvement.
Before you go any further, please read WP:MEDRS and try to understand why we don't use single studies (such as pmid:28962704) to make biomedical claims (such as "Tobacco smoking ... is strongly associated with the premature weakening of fetal membranes.") That will help your edits to stick and not be reverted. Try a site like Trip database or use PubMed to search for systematic and literature reviews and you'll find there are not many secondary sources – pmid:10956448 is about the best one I can find, and that's from 2000.
Finding the best sources and summarising them for a general audience isn't an easy task, but there are many editors here willing to help if you show them that your principal concern is improving the encyclopedia. --RexxS (talk) 23:23, 6 November 2017 (UTC)

Thank you for your suggestions. I have a question about making edits to specific facts. For example, under "classification," prolonged ROM is defined as rupture 24 hours before onset of labor, however, I have seen two separate sources that classify prolonged ROM as 18 hours prior to delivery (Blueprints Obstetrics and Gynecology 6e) OR rupture 24 hours prior to delivery (Elsevier Point of Care). How would you recommend clarifying this? Nrnittur (talk) 00:08, 8 November 2017 (UTC)

@Nrnittur: The procedure for resolving different views is always the same on Wikipedia. You first need to evaluate the quality and quantity of the sources – against the scale at WP:MEDASSESS for medical articles (other subject areas may have their own slightly different criteria). If you have recent good quality secondary sources, then focus on those and leave the primary sources out. If any of the singular views are so far contradictory to what appears to be the mainstream view, they may be discarded as fringe theories. You then examine what views are left. If only one remains, then that may be stated as fact. If different views remain, then they should be attributed to their sources, and each view should be mentioned as that source's opinion, giving weight in proportion to their prominence among the published sources – there's a description of that process at WP:WEIGHT. We should not be offering an editorial judgement on which view is "correct" or "best"; we just summarise as neutrally as we can. It's a lot of work to examine all of the sources, but it has to be done if we're going to do a proper job. Sometimes we end up with nothing better than "X says A, and Y says B". If we actually have a reliable secondary source saying The mainstream view is A then that can be used to qualify multiple views, but we're not competent to draw those conclusions ourselves.
OK, that's not simple, but if you're still unsure, bring your sources here and let other editors offer opinions on them, and you may even find an experienced editor willing to offer some suggestions on how best to summarise them. Hope that helps. --RexxS (talk) 00:55, 8 November 2017 (UTC)

RfC On describing RCOG guidelines, should it include that they are "based on expert opinion not based on clinical evidence"?[edit]

RfC was initially not neutral. Both heading and question were changed well after discussion had begun. Links are now broken and contributions are no longer on the same question.
The following discussion has been closed. Please do not modify it.

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

Background to RfC[edit]

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)
This is a medic matter, and way outside my expertise, but I equally understand the 'medic' argument of identifying the kind of corroboration. To that extent, "expert opinion" on its own is also slightly unclear to the layman, it sounds like an endorsement rather than a kind of verification. I was looking for a form of words satisfactory and informative to both the 'medic' and the lay reader. Pincrete (talk) 21:55, 2 November 2017 (UTC)
in the context of evidence-based medicine, it is both important and relevant that this recommendation is not supported by evidence. it is still recommended, but supported only by expert opinion. There is no contradiction. Things are not always simple. This is the most simple way to say it. Pincrete's suggestion in their "comment" also gets there. Jytdog (talk) 03:06, 3 November 2017 (UTC)
And Boundarylayer, please see your talk page. And for people who might be swayed by that bad argument, please see case-control study and observational study more generally. There are ethical ways to get evidence. Jytdog (talk) 13:32, 3 November 2017 (UTC)
(1)The medical argument for the inclusion of "not clinical evidence", is as far as I can tell, non-existent Pincrete, as the meaning of "expert opinion" is a well understood one within the medical community. To laymen who may not be familiar, we can always interlink to Levels of evidence which should illuminate it for them, if they feel it is some kind of endorsement? In the article we can therefore write "According to the RCOG guidelines of 2012, based on expert opinion, attempted delivery during maternal instability... Such an edit, would also more accurately reflect the source and more generally, how things are presented in the guidelines.
(2)Jytdog it appears that you are somewhat misled, as my reply was specifically responding to Pincrete's understandable statement - "has not been corroborated/tested/similar by clinical trials"? Which is one of a number of understandable mis-interpretations that can and will be generated by this needless qualifier statement - "not based on clinical evidence". To reiterate, this is a very unorthodox qualifier that I have found no precedence of on wikipedia, nor indeed within the source itself.
Boundarylayer (talk) 14:15, 3 November 2017 (UTC)

There comes a point where one can no longer blindly assume good faith. The reality is Boundarylayer is hell-bent on introducing an anti-choice PoV to Wikipedia. A "victory" on this article (via the sledgehammer method of a full RfC on one sentence rather than discussing on the talk page!) will be used to feed into changes to the Death of Savita Halappanavar article, presumably in preparation for articles relating to Ireland's forthcoming referendum to Repeal the Eighth Amendment to Ireland's constitution. As evidence, please see the staggering volume of contributions by this one author - in terms of both number of edits and wall-of-text size of those edits - to this page, a 'sandbox' page to rehearse arguments, and in particular to Talk:Death of Savita Halappanavar. Forum shopping has been used (without notifying other involved editors), wikihounding of at least one other involved editor has taken place, and a block for personal attacks has been issued. In short, this editor should be receiving a topic ban, not be indulged with this RfC. (Which, again, Boundarylayer didn't bother informing other involved editors about... so pinging RexxS and Ebelular.)

On the substantive issue of the RfC, Boundarylayer seems to not quite get sourcing. E.g., they have previously argued - erroneously, and at length - for only WP:RSMED to appear in the Death of Savita Halappanavar article, which couldn't happen for obvious reasons; and, for example, that the Irish newspaper of record and other broadsheets are "tabloids" and not RS... at least until such time as he found a pro-life opinion piece in one and apparently wants to use a quote sourced to "a nurse friend" to attack the standard of public healthcare in Ireland, in which case it presumably stops being a "tabloid" and becomes a RS broadsheet again.

In conclusion - level 4 evidence is expert opinion. Not drawing attention to the fact that it is not based on clinical trials would - per Pincrete and Jytdog serve to mislead the reader. That should not happen and I can only conclude that the intention is, in fact, to mislead the reader. Jytdog's wording is fine. A form of words such as either Pincrete's or "based on expert opinion rather than clinical evidence" also works for me. Apologies for the long response. BastunĖġáḍβáś₮ŭŃ! 17:17, 3 November 2017 (UTC)

  • Comment: I don't accept that this debate meets the conditions for an RfC, principally "Include a brief, neutral statement of or question about the issue" (emphasis is in original). Both the title of this section and the question are clearly biased in their phrasing and this debate cannot be an RfC under those circumstances. Unless there is some reasonable objection, I propose to close and archive this discussion within the next 24 hours. I'm ready to prepare an ANI report on Boundarylayer, asking for a topic ban or indefinite block, if that seems necessary. --RexxS (talk) 18:40, 3 November 2017 (UTC)
Moreover, the fact that I wished to improve this entirely separate article by adding the RCOG medical guidelines, guidelines that really should have already been in this article. As we all agree? That fact, is no loopy "reality of"... "presumedly" this, of anything User:Bastun. How can you even put the words "reality" and "presumedly" together in the same paragraph without having a major cause of cognitive dissonance? Indeed my 'sandbox' page that you conspiratorially bring up was simply material I had written for a discussion that was unfortunately closed to further comment upon the time that I hit submit, so rather than delete the entire reply 5 days ago, I placed it into my sandbox and moved on. If you check the timing, you'd see this yourself. If you had WP:ASSUMEGOODFAITH you wouldn't have jumped to this bizarre Wikipedia:Activist#Hostility - "rehearsal" aspersion. When one starts making these sorts of aspersions, I have to step back and look. When I did, I noticed that the only indisputable "reality" here, is that this PROM article is an article that none of you editors ever edited on before. With the arrival of you all being a conspicuously clear example of Wikipedia:WikiBullying#Wikihounding. Indeed even User:Jytdog only came to this article, after I did. A look at the edit history of this article shows this WP:HOUNDING.
Lastly, the individuals you chose to notify is a clear example of Wikipedia:Canvassing#Votestacking, With User:Bastun selectively notifying an admin? User:RexxS who I last discussed with, 7 days ago alongside a number of other editors. Could this selective notification be because, User:RexxS | publically threatened this very same erroneous "topic ban" back then, that did not get any support due to the similarly un-founded argument that anyone who attempts to improve an article, by removing POV & making it reflect a NPOV. Or adding material that was decided upon as deserving of WP:DUEWEIGHT, that this editor, is somehow, the one that needs to be banned? As this is WP:Canvassing. The point no.4 on WP:EXPLAINBLOCK is in effect when, despite attempts to suggest it. A RfC was started the moment another editor got combative & claimed I was "on a rope". Starting RfCs are how we WP:BUILD consensus & a NPOV encyclopedia. Not Wikipedia:Canvassing#Votestacking and not by creating Wikipedia:POV railroad#False narratives. For example, this is the 2nd time that I have had to tell you to check the Nuclear winter talk page and archives, that will show that my "staggering volume of [talk] edits" is not untypical of me. However you continue to try to use this as major-jumbo "evidence" of me being politically "hell-bent"? Really? When a check of your User talk:Bastun page, shows that it is in fact you with the primary political leaning & general political prolivity. I on the other hand, just care about WP:BUILDing a NPOV encyclopedia that is dependent upon "Medical sources required for medical claims". A check of my edit history shows that.
Boundarylayer (talk) 05:17, 4 November 2017 (UTC)
"Apparently unneutral"? lol! For reference, I notified all of the editors who had been participating on Talk:Death of Savita Halappanavar in the past couple of weeks. I notice now I missed Deacon Vorbis and CFCF. I'd remind you I'm not the editor that got a block for personal attacks. BastunĖġáḍβáś₮ŭŃ! 08:54, 4 November 2017 (UTC)
(No worries, I was basically uninvolved anyway). --Deacon Vorbis (talk) 11:34, 4 November 2017 (UTC)

Wikiproject Peer Review[edit]

Hey guys! Great job!! Seems like you guys made a solid amount of edits with great sources! Everything looks really good to me!

One thing that did stand out is the description of the latency period. A typical reader may be confused by the explanation there so it may be helpful to describe the relationship without relying on the understanding of 'inverse relationships.' However overall it seems like you guys made a significant improvement! — Preceding unsigned comment added by Hpot90 (talkcontribs) 21:53, 15 November 2017 (UTC)