PREMATURE RUPTURE OF THE MEMBRANES (PROM) AT TERM IN NULLIPAROUS WOMEN WITH A RIPE CERVIX - A RANDOMIZED TRIAL OF 12 OR 24 HOURS OF EXPECTANT MANAGEMENT

Objective. To compare maternal and neonatal outcomes after 12 or 24 ho urs of expectant management in healthy nulliparous women with a ripe c ervix and PROM at term. Design. A prospective, randomized study. Locat ion. Karolinska Hospital, Stockholm, Sweden. Subjects. Two hundred and five healthy nulliparous women with singleton pregnancies, cephalic p resentation, gestational duration 36 to 42 weeks, randomized to 12 or 24 hours of expectant management after evaluation of the cervical scor e (>5). If spontaneous labor did not occur, induction was performed wi th oxytocin after 12 or 24 hours, respectively. Main parameters. Mater nal early morbidity and neonatal infections, obstetric intervention ra te (cesarean section or instrumental delivery). Results. The cesarean section rate was 4% in each group. The vacuum extraction rate was 21% in each group. Induction of labor was performed in 47% of the women al located to 12 hours of expectant management vs 17% of the women alloca ted to 24 hours of expectant management (p<0.05). The maternal morbidi ty rate was almost negligible. Only a few fetal infections occurred an d no difference was noted between the groups. Conclusions. In healthy nulliparous women at term with a ripe cervix, expectant management ove r 24 hours vs 12 hours resulted in fewer inductions of labor and no in crease in instrumental deliveries, without any increase in neonatal or maternal morbidity.