MANAGEMENT OF PREMATURE RUPTURE OF THE MEMBRANES AFTER 34 WEEKS GESTATION - EARLY VERSUS DELAYED INDUCTION OF LABOR

Objective, To determine the optimal way to manage patients with premat ure rupture of the membranes after 34 weeks' gestation. Design. A pros pective, randomised controlled trial comparing immediate induction and delayed induction after 24-48 hours, Setting, Tygerberg Hospital, Cap e Town. Participants. Seventy consecutive patients with premature rupt ure of the membranes who presented at Tygerberg Hospital between July and October 1991, Main outcome measures. The two groups were compared with regard to infectious morbidity and antibiotic requirements in the mothers and babies, days spent in hospital, caesarean section rates, duration of labour and analgesic requirements. Results. There was no d ifference between the two groups in terms of infectious morbidity in e ither the mothers or the babies, the duration of labour or the caesare an section rates. Nine patients (26%) in the delayed induction group r equired analgesic treatment during labour versus 18 patients (52%) in the group that was induced immediately (P = 0.049; odds ratio = 0.327; 95% confidence limits = 0.014-0.0998). In the delayed induction group , 74% of the patients went into spontaneous labour during the conserva tive management period. Patients in the active group (immediate induct ion) had a statistically significant better chance of being discharged within 48 hours of admission (P = 0.028; odds ratio = 3.34; 95% confi dence limits = 1.12-10.73), Conclusions. The management of patients wi th premature rupture of the membranes after 34 weeks should be decided upon according to the level of antepartum and neonatal care which is available at the particular unit, Where there is adequate neonatal sup port and pressure on bed occupancy, immediate induction of labour shou ld be considered, while peripheral units should consider conservative management before referral of patients.