CONSERVATIVE AMBULATORY MANAGEMENT OF PRELABOR RUPTURE OF THE MEMBRANES AT TERM IN NULLIPAROUS WOMEN

Objective. To assess maternal and fetal outcome at conservative ambula tory care of nulliparous women at term with prelabor rupture of the me mbranes. Methods. A prospective study of 176 women managed conservativ ely in an ambulatory setting (nonstress test and assessment of amnioti c fluid index every second day). Results. The median rupture of the me mbrane to delivery interval was 30 hours. Ninety per cent were deliver ed within 85 hours. The patients were divided into three groups accord ing to the time period between rupture of membranes and delivery (unde r the 25th, 25th-75th and above the 75th centile). The maternal infect ious morbidity 0, 6, 7% respectively), fetal distress (5, 18, 17% resp ectively) and instrumental delivery rate (5, 16, 16% respectively) ten ded to be increased in the upper three quartiles, without reaching a s tatistically significant level as analysed by chi(2)-test. Nonstress t est or evaluation of amniotic fluid index was not able to predict intr apartum fetal distress. In no case was there a delay in the management of any complication due to the ambulatory care. Conclusion. Awaiting spontaneous labor in nulliparous women with prelabor rupture of the me mbranes at term does not seem to be associated with any obvious advant age. If, however, a conservative attitude is implemented, the patients can preferably be treated on an ambulatory basis.