Prelabour rupture of the membranes at term - No advantage of delaying induction for 24 hours

We performed a prospective randomized study to compare maternal and fetal o utcomes in pregnancies with prelabour rupture of the membranes (PROM) at te rm with early induction of labour or expectant management, 126 women with s ingleton pregnancy, cephalic presentation and gestational duration greater than or equal to 37 weeks, were randomized either to immediate induction of labour with oxytocin (Group 1) (n=52), or conservative management (Group 2 ) (n=74). Women who constituted Group 2 were divided into 2 groups. The fir st group (Group 2A) (n=25) included women in whom spontaneous labour did no t begin after a waiting period of 24 hours, in which case labour was induce d with oxytocin i.e. expectant management. The second group consisted of wo men (Group 2B) (n=49) in whom labour began spontaneously within 24 hours. T he base Caesarean section rate was significantly higher in Group 2 (28.4%) (p<0.05). The rates of Caesarean section in the Groups 1-2A-2B were 19.2%, 60%, and 12.2%, respectively fur nulliparous and parous women together. The rate of fetal distress was significantly higher in Group 2 (p<0.05). For d etermining maternal outcomes, the other parameters such as clinical chorioa mnionitis, fever before or during labour, receiving antibiotics before or d uring labour, postpartum fever, analgesia, anaesthesia did not differ in Gr oups 1 and 2. Women in Group 1 went into active labour sooner, had fewer di gital vaginal examinations, had a shorter interval between membrane rupture and delivery, and spent less time in the hospital before delivery than tho se in Group 2 (p<0.05). Babies in Group 2 were more likely to receive antib iotics, and more likely to stay in an intensive care nursery for more than 24 hours, and more likely to receive ventilation after initial resuscitatio n than those babies in Group 1. For developing apnoea and hypotonia, there was no significant difference between Groups 1 and 2. However, for babies i n Group 2A there was a significant difference. We conclude that immediate i nduction of labour with oxytocin does not increase the risk of Caesarean se ction, compared with a practice of expectant management.Women at term with prelabour rupture of the membranes should therefore be reassured that immed iate induction with oxytocin currently appears to be the best policy with r espect to maternal and neonatal morbidity.