CONTROVERSIES - PRELABOR RUPTURE OF THE MEMBRANES AT TERM - THE CASE FOR EXPECTANT MANAGEMENT

Review of the controlled comparisons between induction of labor and ex pectant care after prelabor rupture of the membranes (PROM) at term in dicates that they are not unhelpful for deciding which of the two opti ons is best. This is, first, because there is a large potential for bi as in the studies reported thus far. Second, the trials are rather het erogeneous and they are comparisons more between early and late induct ion than between induction and expectant care. Third, it is difficult to weigh an increased risk of operative delivery with the induction po licy against an apparently clear, but almost certainly biased, reducti on in the rare occurrence of neonatal infection. With expectant care a bout 70% of women will give birth within 24 hours and 85% within 48 ho urs. The majority of these women will derive little, if any, benefit f rom induction and a routine policy of induction of labor after PROM ca nnot be justified on the basis of the data that are available.