INDUCTION OF LABOR COMPARED WITH EXPECTANT MANAGEMENT FOR PRELABOR RUPTURE OF THE MEMBRANES AT TERM

Background. As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal inf ection. It is not known whether inducing labor will reduce this risk o r whether one method of induction is better than another. Methods. We studied 5041 women with prelabor rupture of the membranes at term. The women were randomly assigned to induction of labor with intravenous o xytocin; induction of labor with vaginal prostaglandin E(2) gel; or ex pectant management for up to four days, with labor induced with either intravenous oxytocin or vaginal prostaglandin E(2) gel if complicatio ns developed. The primary outcome was neonatal infection. Secondary ou tcomes were the need for cesarean section and women's evaluations of t heir treatment. Results. The rates of neonatal infection and cesarean section were not significantly different among the study groups. The r ates of neonatal infection were 2.0 percent for the induction-with-oxy tocin group, 3.0 percent for the induction-with-prostaglandin group, 2 .8 percent for the expectant-management (oxytocin) group, and 2.7 perc ent for the expectant-management (prostaglandin) group. The rates of c esarean section ranged from 9.6 to 10.9 percent. Clinical chorioamnion itis was less likely to develop in the women in the induction-with-oxy tocin group than in those in the expectant-management (oxytocin) group (4.0 percent vs. 8.6 percent, P<0.001), as was postpartum fever (1.9 percent vs. 3.6 percent, P=0.008). Women in the induction groups were less likely to say they liked ''nothing'' about their treatment than t hose in the expectant-management groups. Conclusions. In women with pr elabor rupture of the membranes at term, induction of labor with oxyto cin or prostaglandin E(2) and expectant management result in similar r ates of neonatal infection and cesarean section. Induction of labor wi th intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more pos itively than expectant management.