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Best to wait if waters break early

Expectant management best when membranes rupture before labour

Louise Prime

Wednesday, 25 April 2012

Women whose membranes rupture at 34-37 weeks’ gestation, before labour, should be monitored until they deliver spontaneously rather than be advised to have labour induced, research has shown. The randomised controlled trial, published in PLoS Medicine, found that waiting did not significantly increase the likelihood of problems for the baby or mother.

Researchers in The Netherlands randomly assigned 536 women, whose membranes had spontaneously ruptured at 34-37 weeks’ gestation, to either induction of labour (IoL) within 24 hours, or to expectant management (EM), which involved at least daily maternal temperature monitoring, and twice-weekly blood sampling for maternal leukocyte count and C-reactive protein measurement.

Women in the expectant management group who showed clinical signs of infection, or another fetal or maternal indication that warranted induction, had labour induced. Those who had not delivered by 37 weeks’ gestation had labour induced at that point, or a caesarean section performed if previously planned.

The authors found no statistically significant differences in outcomes between the two group

Neonatal sepsis occurred in 2.6% of babies in the induction of labour group, and 4.1% of those in the expectant management group; respiratory distress syndrome was seen in 7.8% and 6.3% respectively; and delivery was by caesarean section in 13% and 14% of cases.

Pregnancy was, on average, 3.3 days longer in the expectant management group.

The authors concluded: “We found that in pregnancies complicated by [preterm prelabor rupture of the membranes] between 34 and 37 weeks of gestation, IoL does not substantially reduce the incidence of neonatal sepsis compared to EM. The number of neonates with respiratory distress was comparable in both arms, and IoL did not increase the risk of a caesarean section …

“However, in our study IoL increased the risk of hypoglycaemia and hyperbilirubinaemia, as well as the use of epidural or spinal analgesia during labour.”

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