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Early Rupture of Membranes: Induce or Wait?

In almost 10% of women, membranes rupture before labor begins. There is controversy about whether it is best to induce labor or to wait expectantly. This international study compared maternal and fetal outcomes in 5041 women randomized to induction with IV oxytocin, induction with vaginal prostaglandin E₂ gel, or expectant management for up to four days.

All the women were at term. Rates of neonatal infection, the primary endpoint, were 3% or less in all three management groups and did not differ significantly; cesarean-section rates were approximately 10% in all groups. Clinical chorioamnionitis was less common in women induced with oxytocin than in those managed expectantly (4.0% vs. 8.6%, p<0.001), but was not significantly less common in those induced with prostaglandin. Women in the induction groups gave more positive evaluations of their care than those assigned to expectant management.

Comment: The authors conclude that, contrary to earlier studies, expectant management and induction of labor with oxytocin or prostaglandin E₂ lead to similar rates of neonatal infection and C-section. However, the wait-and-watch approach was associated with higher rates of maternal infection and slightly lower patient satisfaction. Overall, this article and an editorial provide good arguments for induction rather than expectant management in this common situation.

— W Levinson

Published in Journal Watch Women's Health May 1, 1996

Citation(s):

Hannah ME et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med 1996 Apr 18 334 1005-1010.

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• Medline abstract (Free)

Duff P. Premature rupture of the membranes at term. N Engl J Med 1996 Apr 18 334 1053-1054.

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• Medline abstract (Free)