A RANDOMIZED TRIAL OF 2 EXPECTANT MANAGEMENTS OF PRELABOR RUPTURE OF THE MEMBRANES AT 34 TO 42 WEEKS

Objective To compare obstetric and perinatal outcome between two diffe rent expectant managements in women with prelabour rupture of the memb ranes (PROM). Design A randomised study. Participants One thousand thr ee hundred and eighty-five women with rupture of the membranes at 34 t o 42 weeks without contractions. Interventions Women without contracti ons 2 h after admission were randomised to early induction the followi ng morning after FROM (early induction group) or induction two days la ter (late induction group). Women with contractions starting within 2 h after admission were included in the calculations as a short latency group. Digital examinations of the cervix were avoided until onset of active labour. Labour was induced with oxytocin in both groups if no spontaneous contractions occurred or if chorioamnionitis or fetal dist ress was detected. Main outcome measures The frequency of spontaneous deliveries, operative deliveries, maternal and neonatal infections. Re sults In nulliparous women, a higher rate of spontaneous deliveries wa s found in the late induction group (89%) compared with the early indu ction group (81%) (P < 0.05). The ventouse extraction rate was 7% and 14% respectively (P < 0.05). A low (2-4%) caesarean section rate was r ecorded and did not differ between the groups. Endometritis was detect ed in six women after delivery. Sixty-one children were treated with a ntibiotics, and no difference could be detected between the groups. Co nclusions A higher rate of spontaneous deliveries was found among null iparous women with prolonged latency as compared with brief latency pr ior to induction. A protocol of no digital examination before labour w as associated with infrequent maternal and fetal morbidity, regardless of latency.