Conservative ambulatory management of prelabor rupture of the membranes at term in nulliparous women.
OBJECTIVE
To assess maternal and fetal outcome at conservative ambulatory care of nulliparous women at term with prelabor rupture of the membranes.


METHODS
A prospective study of 176 women managed conservatively in an ambulatory setting (nonstress test and assessment of amniotic fluid index every second day).


RESULTS
The median rupture of the membrane to delivery interval was 30 hours. Ninety per cent were delivered within 85 hours. The patients were divided into three groups according to the time period between rupture of membranes and delivery (under the 25th, 25th-75th and above the 75th centile). The maternal infectious morbidity (0, 6, 7% respectively), fetal distress (5, 18, 17% respectively) and instrumental delivery rate (5, 16, 16% respectively) tended to be increased in the upper three quartiles, without reaching a statistically significant level as analysed by chi 2-test. Nonstress test or evaluation of amniotic fluid index was not able to predict intrapartum fetal distress. In no case was there a delay in the management of any complication due to the ambulatory care.


CONCLUSIONS
Awaiting spontaneous labor in nulliparous women with prelabor rupture of the membranes at term does not seem to be associated with any obvious advantage. If, however, a conservative attitude is implemented, the patients can preferably be treated on an ambulatory basis.
Hagskog
K
K
Department of Obstetrics and Gynecology, Huddinge University Hospital, Karolinska Institutet, Sweden.
Nisell
H
H
Sarman
I
I
Westgren
M
M
D000328:Adult; D000553:Ambulatory Care; D000653:Amniotic Fluid / Q000737:chemistry; D036861:Delivery, Obstetric / Q000295:instrumentation / Q000379:methods; D005260:Female; D005316:Fetal Distress / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D009772:Obstetrical Forceps; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors