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PRELABOR RUPTURE OF MEMBRANES AT TERM: INDUCE OR WAIT?

What is the optimal approach when a pregnant woman's membranes rupture at term, but before labor starts? This study from Europe, Canada, Israel, and Australia randomized over 5000 such women at 37 or more weeks' gestation to four groups: induction with oxytocin; induction with prostaglandin E2 vaginal gel; or expectant management followed by induction by either oxytocin or prostaglandin if there was fetal or maternal compromise, or no spontaneous labor within four days. Labor was eventually induced in about 20 percent of women in the expectant management groups.

Rates of neonatal infection and cesarean section (about 3 and 10 percent, respectively) were not significantly different in the four groups. Maternal chorioamnionitis was less frequent in the induction/oxytocin group than in the expectant/oxytocin group (4 vs. 8.6 percent). Induced women appeared slightly more satisfied with their treatment than women treated expectantly.

Comment: These authors conclude that induction of labor and expectant management are both "reasonable options" for women with prelabor rupture of membranes at term. However, an editorialist believes that expectant management "should be abandoned" because of the possibility of increased infection rates, increased hospital expense, and patients' less favorable ratings.

— AS Brett

Published in Journal Watch General Medicine May 3, 1996

Citation(s):

Hannah ME et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med 1996 Apr 18 334 1005-1010.

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Duff P. Premature rupture of the membranes at term. N Engl J Med 1996 Apr 18 334 1053-1054.

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• Medline abstract (Free)