Prelabor Rupture of Membranes at Term: Induce or Wait?
Rupture of the fetal membranes prior to the onset of labor is a common event. With its occurrence, the risk is increased for serious maternal and fetal infections, dysfunctional labor, and the need for operative delivery. Fortunately, for most women with prelabor rupture of membranes (PROM) at term, labor begins spontaneously in the hours following membrane rupture. If spontaneous labor does not commence shortly after PROM at term, and the patient's cervix is favorable, labor induction should be initiated. Women with uncomplicated gestations who have an unfavorable cervical score may be managed expectantly, undergo immediate labor induction, or be observed for an arbitrary time period and then undergo labor induction. Recent clinical trials have shown that immediate labor induction for women with PROM at term and an unfavorable cervical score is preferable in the context of maternal and neonatal outcome, cost-effectiveness, and patient satisfaction.
Yancey
MK
Maternal-Fetal Medicine Service, at the Tripler Army Medical Center in Hawaii.