PREMATURE RUPTURE OF MEMBRANES AT TERM WITH AN UNFAVORABLE CERVIX - COMPARISON OF EXPECTANT MANAGEMENT, VAGINAL PROSTAGLANDIN, AND OXYTOCININDUCTION

Background. Our objective was to determine the best treatment for part urients at term with an unfavorable cervix and premature rupture of me mbranes (PROM). Methods. In this prospective study, 96 women with PROM and an unfavorable cervix were randomized into one of three treatment groups: oxytocin induction, vaginal prostaglandin E-2 gel followed by oxytocin, or expectant management. Results. Length of labor, cesarean section rate, and maternal/neonatal morbidity were not significantly different. In contrast, the interval from PROM until delivery and leng th of hospital stay were significantly longer in the expectantly manag ed group than in the other groups. Four of the patients who received e xpectant management required delivery because of nonreassuring fetal a ssessments. Conclusions. Expectant management of PROM at term signific antly prolongs hospital stay without decreasing the incidence of abdom inal delivery or infectious morbidity. There appears to be potential f or cord compression in patients managed expectantly without continuous electronic fetal surveillance.