Prelabour rupture of membranes at term: early induction of labour versus expectant management

doi:10.1016/S0301-2115(95)02586-3

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 70, Issue 2, 27 December 1996, Pages 129-133

https://doi.org/10.1016/S0301-2115(95)02586-3 Get rights and content

Abstract

Objectives: To compare expectant management with early induction of labour in pregnant patients with prelabour rupture of membranes at term and unfavourable cervix. Study design: A prospective, randomised study of 154 women with prelabour rupture of membranes at term of whom 80 had been managed expectantly, and 74 had undergone oxytocin induction at a rate of 2.5 mU/min. Digital examination was not performed before oxytocin infusion, and the first was delayed until 4 h (nulliparae), or 2 h (multiparae) of regular uterine contractions. Results: The mean period from rupture of membranes to delivery was significantly shorter in the induction group. The mean duration of labour was significantly shorter in the expectant group. Operative vaginal deliveries were more common in the induction group, and fetal distress was the most common cause of operative vaginal deliveries. The caesarean rates were low and similar in both groups. Maternal and neonatal infectious morbidity was similar and no difference was found in the length of hospitalisation. Conclusions: Expectant management in patients with ruptured membranes at term is safe and reduces the frequency of operative vaginal deliveries.

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Cited by (32)

Pre-labour Rupture of Membranes at Term in Women With Gestational Diabetes and the Risk of Neonatal Hypoglycemia
2024, Journal of Obstetrics and Gynaecology Canada
The management for improving maternal and neonatal outcomes of women with gestational diabetes mellitus (GDM) arriving at the delivery ward with pre-labour rupture of membranes (PROM) has not been elucidated. We tested the hypothesis that prolonged PROM in women with GDM would result in higher rates of neonatal hypoglycemia.
We retrospectively enrolled women with diet or insulin-controlled GDM who presented with spontaneous clear PROM. Each woman was allocated into one of two groups based on the PROM-delivery time: <18 hours (group 1) and ≥18 hours (group 2). The primary outcome was the incidence of neonatal hypoglycemia, defined as glucose <40 mg/dL (2.2 mmol/L) within 24 hours of birth.
We ultimately analyzed 631 cases of GDM (6.7%), 371 with PROM-delivery <18 hours, and 260 with PROM-delivery ≥18 hours. The incidence of neonatal hypoglycemia did not differ between the two groups, reaching 7.3%. Women in group 2 were at increased risk of both cesarean delivery (20% vs. 12.4%, P < 0.01) and maternal chorioamnionitis morbidity (6.5% vs. 1.3%, P < 0.001).
In a sub-group of women with GDM, a PROM-delivery time ≥18 hours is not associated with higher rates of neonatal hypoglycemia, but higher rates of chorioamnionitis and cesarean delivery were noted. Therefore, we suggest consideration for early delivery when managing women with GDM and PROM.
La prise en charge recommandée pour améliorer les issues maternelles et néonatales n’a pas été établie pour les femmes atteintes de diabète sucré gestationnel (DSG) qui se présentent à l’unité des naissances avec une rupture prématurée des membranes avant terme (RPMAT). Nous avons testé l’hypothèse selon laquelle une RPMAT prolongée chez les femmes atteintes de DSG serait associée à une augmentation du risque d’hypoglycémie néonatale.
Nous avons inclus de façon rétrospective des femmes dont le DSG était régulé par l’insuline ou l’alimentation et qui ont été admises pour une RPMAT spontanée avec écoulement de liquide clair. Chaque femme a été affectée à l’un des deux groupes en fonction du délai RPMAT-accouchement : < 18 heures (groupe 1) et ≥ 18 heures (groupe 2). Le critère de jugement principal était l’incidence de l’hypoglycémie néonatale, définie comme une glycémie inférieure à 40 mg/dl (2.2 mmol/l) dans les 24 heures suivant l’accouchement.
Au total, nous avons analysé 631 cas (6.7 %) : le délai RPMAT-accouchement était inférieur à 18 heures dans 371 cas et d’au moins 18 heures dans 260 cas. L’incidence de l’hypoglycémie néonatale n’a pas varié entre les deux groupes, atteignant un taux de 7,3 %. Les femmes du groupe 2 présentaient un risque accru d’accouchement par césarienne (20 % p/r à 12,4 %, P < 0,01) et de chorioamniotite maternelle (6,5 % p/r à 1,3 %, P < 0,001).
Dans un sous-groupe de femmes atteintes de DSG, un délai RPMAT-accouchement de 18 heures ou plus n’est pas associé à un taux plus élevé d’hypoglycémie néonatale, mais une augmentation des risques de chorioamnionite et de césarienne a été relevée. Par conséquent, nous suggérons d’envisager un accouchement rapide chez les femmes atteintes de DSG avec une RPMAT.
Term prelabor rupture of membranes: immediate induction is the optimal management
2023, American Journal of Obstetrics and Gynecology MFM
Term prelabor rupture of membranes, defined as rupture of membranes before the onset of labor at ≥37 weeks of gestation, is a common obstetrical event occurring in 8% of pregnancies. However, most relevant guidelines are inconclusive regarding the management of this condition and the optimal timing of induction of labor. Here, we present evidence from randomized controlled trials and a recent meta-analysis indicating that an immediate induction of labor in term premature rupture of membranes is associated with several maternal and neonatal benefits compared with expectant management, without increasing the risk of cesarean delivery. Given these findings, we strongly believe that immediate induction of labor is the optimal management strategy in case of term prelabor rupture of membranes.
Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM study
2023, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Given that the risk for chorioamnionitis increases progressively with time following PROM,1,8–13 it is reasonable to assume that early induction is the best strategy to decrease the risk for associated maternal and neonatal infectious morbidity. However, most of the trials addressing this question are of low-to-moderate quality and are limited by small sample sizse, limited information on the timing of labor induction from the onset of PROM, and lack of precise definitions for the outcome measures.7,15,18–28 More importantly, these studies vary considerably with respect to the definitions for early induction and expectant management.
In the case of prelabor rupture of membranes at term, the risk for neonatal and maternal infectious morbidity increases progressively with time from prelabor rupture of membranes. Although most studies identified a benefit associated with early induction within the first 24 hours following term prelabor rupture of membranes, there is currently no precise data regarding how early should induction be scheduled.
This study aimed to identify the optimal timing of labor induction among women with term prelabor rupture of membranes by comparing the maternal and neonatal outcomes associated with labor induction with those of expectant management at any given 1-hour interval following prelabor rupture of membranes.
This was a secondary analysis of data from the TERMPROM trial, an international, multicenter, randomized clinical trial on immediate delivery vs expectant management of women with prelaor rupture of membranes at term (≥37+0/7 weeks’ gestation). We considered all participants as a single cohort of women with term prelabor rupture of membranes, irrespective of the original randomized study group allocation. For each given 1-hour time interval within the first 36 hours following prelabor rupture of membranes, we compared the outcomes of subjects for whom labor induction was initiated during this interval with those of subjects managed expectantly at the same time interval. The primary neonatal outcome was a composite of neonatal infection and admission to the neonatal intensive care unit. The primary maternal outcomes included maternal infection (clinical chorioamnionitis or postpartum fever) and cesarean delivery.
Of the 4742 subjects who met the study criteria, 2622 underwent labor induction, and 2120 experienced a spontaneous onset of labor. The rates of the neonatal composite outcome, neonatal admission to intensive care unit, and maternal infection increased progressively with time after prelabor rupture of membranes. The risk for these outcomes was lower among women who underwent induction when compared with those managed expectantly within the first 15 to 20 hours after prelabor rupture of membranes without affecting the risk for cesarean delivery. In addition, women who underwent labor induction within the first 30 to 36 hours had a shorter prelabor rupture of membranes to delivery time and a shorter total maternal hospital stay when compared with those managed expectantly at the same time interval. Among women managed expectantly, less than two-thirds (64%; 1365/2120) experienced a spontaneous onset of labor within the first 24 hours following prelabor rupture of membranes.
These findings suggest that immediate labor induction seems to be the optimal management strategy to minimize neonatal and maternal morbidity in the setting of prelabor rupture of membranes at term gestations. In cases for which immediate induction is not feasible, labor induction remains the preferred option over expectant management if performed within the first 15 to 20 hours after prelabor rupture of membranes.
Preterm and term prelabour rupture of membranes: A review of timing and methods of labour induction
2021, Best Practice and Research: Clinical Obstetrics and Gynaecology
Citation Excerpt :
Neonatal infection is a rare event, inconsistently defined in published studies assessing tPROM management. Those studies comparing AM and EM in tPROM have never considered neonatal infection rates as a primary outcome; moreover, they have had small sample sizes and reported inconsistent use of antibiotics or inconsistent definitions of neonatal infection (definite or probable) [62–64,66,67,71,73,76,78–85]. Only one large high-quality RCT, the TERMPROM study, was designed to show a 50% reduction in the frequency of neonatal infection (with an assumed baseline neonatal infection rate of 4%) [10].
Prelabour rupture of membranes (PROM) exposes both foetuses and mothers to the risk of infection. Induction of labour has been proposed to reduce this risk, but its neonatal and maternal risks and benefits must be balanced against those of expectant management (EM). Recent randomized studies of preterm PROM show that EM until 37 weeks of gestation is associated with lower overall neonatal morbidity. In term PROM, active management is associated with a shorter birth interval but not with lower rates of neonatal infection. Similar maternal and neonatal outcomes are reported regardless of whether induction uses oxytocin, PGE2, or oral misoprostol.
Induction within or after 12 hours of ≥36 weeks’ prelabor rupture of membranes: a systematic review and meta-analysis
2021, American Journal of Obstetrics and Gynecology MFM
Citation Excerpt :
It has been well known for more than 50 years that the shorter the time between term PROM and delivery, the lower the maternal morbidity and perinatal morbidity and mortality.1 The Cochrane Review addressing IOL vs expectant management for term PROM does not address the issue of IOL <12 or <6 hours and does not include RCTs included in our meta-analysis.3,6,9 The Society guidelines also do not address the issue of IOL within 24 hours, for example, at <12 or <6 hours.12–14
This study aimed to evaluate the incidence of chorioamnionitis in women with singleton gestations with ≥36 weeks’ prelabor rupture of membranes induced with oxytocin within or after 12 hours of prelabor rupture of membranes.
The search was conducted using MEDLINE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library as electronic databases from their inception to May 2020.
Randomized controlled trials of women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks comparing induction of labor with oxytocin either ≤12 hours after prelabor rupture of membranes or >12 hours after prelabor rupture of membranes (expectant management group).
The risk of bias in each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. The primary outcome was the incidence of chorioamnionitis.
After exclusions, 9 randomized controlled trials including 3759 women were analyzed. Women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks who have induction of labor ≤12 hours after prelabor rupture of membranes have shorter time between prelabor rupture of membranes and delivery (−12.68 hours; 95% confidence interval, −16.15 to −9.21) and higher chance of delivering within 24 hours of prelabor rupture of membranes (91% vs 46%; relative risk, 1.93; 95% confidence interval, 1.59–2.35). Cesarean and operative vaginal deliveries were not significantly different between the groups. Induction of labor ≤12 hours after prelabor rupture of membranes was also associated with significantly fewer incidences of chorioamnionitis (5.3% vs 9.9%; relative risk, 0.62; 95% confidence interval, 0.40–0.97), endometritis (2.4% vs 4.2%; relative risk, 0.59; 95% confidence interval, 0.40–0.87), neonatal sepsis (6.1% vs 11.8%; relative risk, 0.46; 95% confidence interval, 0.27–0.79), and admission to neonatal intensive care unit (6.4% vs 12.0%; relative risk, 0.54; 95% confidence interval, 0.43–0.69) compared with women managed expectantly, usually at >24 hours. The subgroup analysis of 3323 women with induction of labor at ≤6 hours showed similar results, including similar significant reductions in chorioamnionitis, endometritis, neonatal sepsis, and admission to neonatal intensive care unit.
Women with symptoms of prelabor rupture of membranes at ≥36 weeks should be evaluated promptly, and if prelabor rupture of membranes is confirmed, they should have induction of labor within 12 hours and perhaps even within 6 hours since the first symptom of prelabor rupture of membranes. This management is associated with significantly less morbidity, especially in terms of infections, for both the mother and the baby, with no evidence of any harm.
Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice — Timing of Labor Induction
2020, Gynecologie Obstetrique Fertilite et Senologie
Comparer les issues maternelles et néonatales entre l’attitude interventionniste (déclenchement immédiat) et l’attitude expectative en cas de rupture des membranes à terme avant travail (RMTAT).
Consultation des bases de données Medline, de la Cochrane Library et des recommandations des sociétés savantes.
En cas de rupture des membranes à terme, le déclenchement permet de raccourcir le délai entre la rupture des membranes et l’accouchement en comparaison avec l’expectative quand il est réalisé par oxytocine (NP2), prostaglandines E2 (NP2), ou misoprostol (NP2). Les études concernant la sonde de Foley® (NP2), les dilatateurs osmotiques (NP2) et l’acupuncture (NP2) ne mettent pas en évidence de raccourcissement du délai entre la rupture des membranes et l’accouchement (NP2). Les données les plus robustes à ce jour sont extraites d’un large essai randomisé international, le TERMPROM study, ayant inclus plus de 5000 patientes entre 1992 et 1995, et ayant comparé un déclenchement immédiat par prostaglandines ou par oxytocine à une expectative jusqu’à 96 h, suivie d’un déclenchement par prostaglandines ou oxytocine. Dans cet essai, le déclenchement immédiat n’était pas associé à une réduction de l’infection néonatale en comparaison à une attitude expectative (NP1), et ce quel que soit le statut des patientes pour le streptocoque B (NP2). L’attitude expectative peut donc être proposée sans augmenter le risque infectieux néonatal (Grade B). Le déclenchement par oxytocine (NP2), et non par prostagandines (NP2), était associé à une réduction du risque d’infection intra-utérine et de fièvre du post-partum en comparaison à l’expectative dans cet essai. Cependant, celui-ci présentait des limites de validité externe (statut des patientes pour le streptocoque B inconnu au moment de l’accouchement et faible taux d’antibioprophylaxie) et les autres essais randomisés de plus faible effectif ne mettaient pas en évidence de différence de morbidité infectieuse entre le groupe déclenchement et le groupe expectative. Concernant le risque de césarienne, dans le TERMPROM study, le déclenchement n’était pas associé à une augmentation ou une réduction du taux de césarienne en comparaison à une attitude expectative (NP2), quels que soient la parité (NP2) et le score de Bishop (NP3). Un déclenchement peut donc être proposé sans augmenter le risque de césarienne (Grade B). Aucune étude n’a évalué une expectative supérieure à 4 jours.
En cas de RMTAT, l’attitude expectative peut être proposée sans augmenter le risque infectieux néonatal (Grade B), et ce même en cas de dépistage positif pour le streptocoque B (Accord professionnel), et un déclenchement peut être proposé sans augmenter le risque de césarienne (Grade B). Le moment du déclenchement dépendra donc principalement de l’organisation des soins en maternité et de la préférence des femmes après les avoir informées des risques et bénéfices des deux stratégies possibles (Accord professionnel). En cas de liquide méconial ou de rupture des membranes > 4 jours, il est recommandé de proposer un déclenchement (Accord professionnel).
To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes.
We searched Medline Database, Cochrane Library and consulted international guidelines.
In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96 hours, followed by induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days.
In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women's preference after having informed them of the risks and benefits associated with induction and expectant management (Professional consensus). In case of meconial fluid or term prelabor rupture of membranes > 4 days, induction must be offered (Professional consensus).

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Prelabour rupture of membranes at term: early induction of labour versus expectant management

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

The aggressive management of ruptured membranes

Am J Obstet Gynecol

Fetal hazard after rupture of the membranes

Obstet Gynecol

Incidence of fetal and maternal complications associated with rupture of the membranes before onset of labour

Am J Obstet Gynecol