title: Relationship of antepartum pelvic examinations to premature rupture of the membranes.
abstract: A retrospective analysis of 273 term deliveries over a four-month period in an Air Force Regional Hospital revealed an 11% incidence of patients seen at term with premature rupture of membranes (PROM) and not in active labor who required induction of labor. The incidence of primary cesarean section in this group was found to be more than twice that of the remaining group of patients, who were seen early in labor with intact membranes, or who had spontaneous rupture of the membranes after the onset of labor. Although this incidence was not statistically significant, it did represent a worrisome trend. Therefore, a randomized prospective study was performed over the next six months to determine whether or not elective antenatal pelvic examinations might contribute to this problem. A total of 349 patients were studied. In 175 patients in whom no pelvic examinations were done until term or past term, the incidence of PROM was found to be 6%. In the 174 patients in whom pelvic examinations were done weekly starting at 37 weeks' gestation, the incidence was 18%, which was a significant increase (P = .001). The primary cesarean section rate was comparable in both groups with PROM; however, the overall primary cesarean section rate when PROM occurred was found to be twice that of the remaining population. This, however, did not achieve statistical significance. The study suggests that pelvic examinations before term may be a significant contributing factor to the incidence of PROM.
mesh_terms: D002585:Cesarean Section; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D010388:Pelvis; D010808:Physical Examination; D011247:Pregnancy; D011295:Prenatal Care; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D011897:Random Allocation; D012189:Retrospective Studies