Induction of Labor in Patients with Term Premature Rupture of Membranes

Abstract

Objective: To determine whether delayed induction of labor in patients with premature rupture of membranes (PROM) at term has beneficial effects on the mother or the infant. Study Design: Retrospective analysis of our database revealed 576 patients >37 weeks of gestation with PROM, who delivered live-born infants without major congenital anomalies. We analyzed the frequencies of primary cesarean, neonatal intensive care unit (NICU) admissions, and oxytocin use by time since hospital admission and interval until onset of labor. Results: NICU admission increased from 1.9% in <3 h between admission to onset of labor to 13.3% after >18 h. Admission-onset of labor interval, birth weight of <2,500 or >4,000 g and meconium were all more important determinants of NICU admission than gestational age, duration of labor, PROM, and ROM. Prolonged admission-onset of labor interval was associated with an increased risk of variable decelerations (p < 0.001). Primary cesarean rates increased progressively with longer intervals between admission and onset of labor. Stepwise discriminant function analysis revealed that labor duration, admission-onset of labor interval, gestational age, and birth weight of <2,500 g were all more important determinants of primary cesarean delivery than the durations of PROM or ROM. Conclusions: The increased frequencies of NICU admission, variable decelerations, and primary cesarean suggest that delayed labor induction after hospital admission was linked to worsened perinatal outcomes. These results may have been influenced by usually performing a single digital examination as part of initial evaluation of term patients who present with PROM. Based on our data, we suggest immediate induction for PROM at term, especially if digital examination has been performed.

A Comparative Study of Immediate Induction and Twelve Hour Expectant Management of Labour in Term Premature Rupture of Membranes

“…Seaward et al had identified an increased number of vaginal examinations as the predictor of neonatal infection (11) . Hallak and Bottoms suggested immediate induction for PROM at term especially if digital examination has been performed based on worse perinatal and maternal outcome with delayed labour induction when vaginal examination was part of initial evaluation of patients with PROM (12) . There were no statistical differences in the incidence of neonatal sepsis evaluation, apgar scores, babies who were RDT + ve between the 2 groups.…”

Expectant versus active management in term prelabor rupture of membranes (PROM) - a prospective study in a tertiary care hospital

“…Term PROM is an obstetric conundrum which is poorly defined with a multitude of obscure etiologies associated with significant maternal and fetal morbidity and has diverse and controversial management strategies 1,[4][5][6][7] . Expectant management entails the increased risk of chorioamnionitis and its consequences and active interference brings with it the risk of C-Section 4 -7 .…”