A randomized trial of management of pre-labor rupture of membranes at term in multiparous women using vaginal prostaglandin gel.
OBJECTIVE
To compare conservative management of pre-labor spontaneous rupture of membranes (SROM) with the use of prostaglandin (PG) E2 in healthy parous women at term (gestational age at least 37 weeks).


METHODS
An open randomized study was conducted with 100 parous women; 50 were treated conservatively for 24 hours, and 50 were managed actively using PGE2 gel (1 mg), administered at admission and repeated 6 hours later if labor was not established. Both groups received intravenous oxytocin if labor did not start within 24 hours after admission.


RESULTS
The use of PGE2 gel led to a significant reduction in the mean interval (+/- standard error of the mean) from SROM to onset of labor: 17.26 +/- 1.51 hours in the conservative group versus 6.50 +/- 1.23 in the PGE2 group. A significantly smaller proportion of subjects required oxytocin in the PGE2 group (12 versus 38%, P < .02). The two groups were comparable with respect to analgesic requirements. Within 24 hours of SROM, 80% of the women in the PG group and 56% in the conservative group had delivered (P < .02). Most women delivered vaginally, 96% of those managed conservatively and 100% of those managed actively with PGE2.


CONCLUSIONS
Active management using PGE2 gel in parous women with pre-labor SROM significantly improves the time to delivery without influencing the cesarean rate or fetal-maternal infective morbidity.
Mahmood
T A
TA
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Scotland.
Dick
M J
MJ
D000282:Administration, Intravaginal; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000379:methods*; D015232:Dinoprostone / Q000627:therapeutic use*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D005782:Gels; D006801:Humans; D007745:Labor Onset / Q000187:drug effects; D010121:Oxytocin / Q000627:therapeutic use*; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors
D000900:Anti-Bacterial Agents; D005782:Gels; D010121:Oxytocin; D015232:Dinoprostone