INDUCTION VERSUS EXPECTANT MANAGEMENT IN PREMATURE RUPTURE OF THE MEMBRANES WITH MATURE AMNIOTIC-FLUID AT 32 TO 36 WEEKS - A RANDOMIZED TRIAL

OBJECTIVE: Our objective was to compare maternal and perinatal outcome s between two management schemes for women with preterm premature rupt ure of the membranes and documented fetal pulmonary maturity. STUDY DE SIGN: Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting wom en were randomly selected for either induction of labor (n = 46) or ex pectant management (n = 47). Expectant management included hospitaliza tion, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progre ssive labor occurred. Follow-up was also done for. the 71 women who di d not participate. RESULTS: The women in the induction of labor and ex pectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associ ated with prolonged latencies to labor, delivery, and maternal hospita lization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%) These latter differences wer e influenced by the neonatologist's concern over potential neonatal in fection. CONCLUSIONS: Among women with preterm premature rupture of th e membranes at 32 to 36 weeks with mature surfactant profiles, immedia te induction of labor reduces the duration of hospitalization and infe Ction in both mothers and neonates.