Induction of labour versus expectant management in women with preterm prelabour rupture of membranes between 34 and 37 weeks (the PPROMEXIL-trial).
BACKGROUND
Preterm prelabour rupture of the membranes (PPROM) is an important clinical problem and a dilemma for the gynaecologist. On the one hand, awaiting spontaneous labour increases the probability of infectious disease for both mother and child, whereas on the other hand induction of labour leads to preterm birth with an increase in neonatal morbidity (e.g., respiratory distress syndrome (RDS)) and a possible rise in the number of instrumental deliveries.


METHODS
We aim to determine the effectiveness and cost-effectiveness of immediate delivery after PPROM in near term gestation compared to expectant management. Pregnant women with preterm prelabour rupture of the membranes at a gestational age from 34+0 weeks until 37+0 weeks will be included in a multicentre prospective randomised controlled trial. We will compare early delivery with expectant monitoring. The primary outcome of this study is neonatal sepsis. Secondary outcome measures are maternal morbidity (chorioamnionitis, puerperal sepsis) and neonatal disease, instrumental delivery rate, maternal quality of life, maternal preferences and costs. We anticipate that a reduction of neonatal infection from 7.5% to 2.5% after induction will outweigh an increase in RDS and additional costs due to admission of the child due to prematurity. Under these assumptions, we aim to randomly allocate 520 women to two groups of 260 women each. Analysis will be by intention to treat. Additionally a cost-effectiveness analysis will be performed to evaluate if the cost related to early delivery will outweigh those of expectant management. Long term outcomes will be evaluated using modelling.


CONCLUSIONS
This trial will provide evidence as to whether induction of labour after preterm prelabour rupture of membranes is an effective and cost-effective strategy to reduce the risk of neonatal sepsis. CONTROLLED CLINICAL TRIAL REGISTER: ISRCTN29313500.
van der Ham
David P
DP
Department of Obstetrics and Gynaecology, VieCuri Medical Centre Venlo, the Netherlands. dpvanderham@zonnet.nl
Nijhuis
Jan G
JG
Mol
Ben Willem J
BW
van Beek
Johannes J
JJ
Opmeer
Brent C
BC
Bijlenga
Denise
D
Groenewout
Mariette
M
Arabin
Birgit
B
Bloemenkamp
Kitty W M
KW
van Wijngaarden
Wim J
WJ
Wouters
Maurice G A J
MG
Pernet
Paula J M
PJ
Porath
Martina M
MM
Molkenboer
Jan F M
JF
Derks
Jan B
JB
Kars
Michael M
MM
Scheepers
Hubertina C J
HC
Weinans
Martin J N
MJ
Woiski
Mallory D
MD
Wildschut
Hajo I J
HI
Willekes
Christine
C
D003362:Cost-Benefit Analysis; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000191:economics* / Q000517:prevention & control / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000191:economics / Q000517:prevention & control; D007751:Labor, Induced / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics*; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D047929:Term Birth