Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial.
OBJECTIVE
Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity.


METHODS
Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate.


RESULTS
The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection.


CONCLUSIONS
Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates.
Mercer
B M
BM
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
Crocker
L G
LG
Boe
N M
NM
Sibai
B M
BM
D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000628:therapy*; D005323:Fetal Monitoring; D005325:Fetal Organ Maturity; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007751:Labor, Induced; D007902:Length of Stay; D008168:Lung / Q000196:embryology*; D009017:Morbidity; D010121:Oxytocin / Q000008:administration & dosage / Q000627:therapeutic use; D010808:Physical Examination; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D015145:Tocolysis
D010121:Oxytocin