Inducing for Premature Rupture of Membranes Not Better

No improvement in pregnancy outcomes for women with preterm prelabor rupture of membranes

WEDNESDAY, April 25 (HealthDay News) -- In pregnant women with preterm prelabor rupture of membranes (PPROM), inducing labor and watchful waiting are similarly effective in terms of pregnancy outcomes such as neonatal sepsis and cesarean section, according to a study published online April 24 in PLoS Medicine.

David P. van der Ham, M.D., from the Maastricht University Medical Center in the Netherlands, and colleagues randomly assigned 536 pregnant women with PPROM at 34 to 37 weeks' gestation to induction of labor or expectant management.

The researchers found relative risks for induction of labor versus expectant management of 0.64 (95 percent confidence interval [CI], 0.25 to 1.6) for neonatal sepsis, 1.3 (95 percent CI, 0.67 to 2.3) for respiratory distress syndrome, and 0.98 (95 percent CI, 0.64 to 1.50) for cesarean section, none of which reached statistical significance. The relative risk of chorioamnionitis was significantly lower in the induction of labor group. There were no serious adverse events. Including this trial in a previous meta-analysis showed that the relative risk was 1.06 (95 percent CI, 0.64 to 1.76) for neonatal sepsis and 1.27 (95 percent CI, 0.98 to 1.65) for cesarean section.

"In women whose pregnancy is complicated by late PPROM, neither our trial nor the updated meta-analysis indicates that induction of labor substantially improves pregnancy outcomes compared with expectant management," van der Ham and colleagues conclude. "Because of wide differences in general health care and availability of antibiotics, it is likely that these results cannot be generalized to low-income countries."

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