Timing of labor induction after premature rupture of membranes between 32 and 36 weeks' gestation

OBJECTIVE: The objective was to determine a consensus gestational age for l abor induction after premature rupture of membranes between 32 and 36 weeks ' gestation on the basis of the relative frequencies of adverse neonatal ou tcomes. STUDY DESIGN: A retrospective review was undertaken of all patients with pr emature rupture of membranes between 32 and 36 weeks' gestation. These pati ents were managed expectantly whenever possible. Neonatal outcomes were str atified by gestational age at rupture of membranes. RESULTS: Two hundred thirty-six patients with rupture of membranes between 32 and 36 weeks' gestation were managed expectantly. Prolongation of pregna ncy by greater than or equal to 1 week was infrequent in all cases, particu larly if membrane rupture occurred after 34 weeks' gestation. Reductions in the neonatal length of stay and the incidence of hyperbilirubinemia were o bserved at 34 weeks' gestation with respect to younger gestational ages. No perinatal deaths occurred among the study cases. CONCLUSIONS: A "break point" in neonatal morbidity was observed at 34 weeks ' gestation, which supports induction of labor at this gestational age. The short latencies observed limit the potential benefits of expectant managem ent.