Predictors of cesarean delivery after prelabor rupture of membranes at term

Objective: To identify the significant predictors of cesarean delivery afte r prelabor rupture of membranes (PROM) at term. Methods: In a multicenter study involving 72 institutions in six countries, 5041 women were randomized to induction of labor with oxytocin or prostagl andins or to expectant management. We did univariate and multivariate logis tic regression analyses to determine the statistically significant independ ent predictors of cesarean delivery (P < .05). Results: The following variables were found to be significantly associated with cesarean delivery: delivery in Israel, versus Canada (odds ratio [OR] 0.34); delivery in Australia, versus Canada (OR 1.93); nulliparity (OR 2.81 ); labor lasting more than 12 hours, versus less than 6 hours (OR 2.78); la bor lasting 6-12 hours, versus less than 6 hours (OR 1.66); previous cesare an delivery (OR 2.75); epidural anesthesia (OR 2.66); clinical chorioamnion itis (OR 2.42); internal fetal heart rate monitoring (OR 2.19); birth weigh t of at least 4000 g (OR 2.07); use of oxytocin (OR 1.97); maternal age of at least 35 years (OR 1.44); latent period of at least 12 hours (OR 1.41); and meconium staining (OR 1.41). Conclusion: Strong predictors of cesarean delivery after FROM at term were country of birth, nulliparity, long labor, previous cesarean delivery, and epidural anesthesia. (Obstet Gynecol 1999;93:1031-5. (C) 1999 by The Americ an College of Obstetricians and Gynecologists.).