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Study: Watching and Waiting is Best When Waters Break Early

A new study suggests that women who have late preterm rupture of the membranes (between 34-37 weeks) are best managed by monitoring and waiting until the baby is born, rather than inducing the labor with medication.

In the movies the waters always break first, a hand shoots up for a taxi and the next thing you know mom’s on a gurney. In real life, most women (about 85%) find that their waters break during labor– it could happen in early labor, active labor or pushing. On rare occasion the baby is born in the sac which is fine and considered a blessing in some cultures.

Only about 15% of pregnant women have what’s called premature rupture of the membranes (PROM)– of this group most will go into labor on their own within 24 hours.

Only 3% of women find their waters break before labor has started and before term: This is called preterm premature rupture of the membranes (PPROM). The study, conducted by Dutch researchers, applies to this group.
According to a release, David van der Ham, from the Maastricht University Medical Center, Netherlands, and colleagues “randomized over 500 pregnant women with preterm pre-labor rupture of the membranes between 34-37 weeks gestation to receive either immediate induction of labor or expectant management (monitoring and waiting).”

They found that there were no statistically significant differences in the number of babies who had a blood infection or respiratory distress syndrome between the two groups. The c-section rates were not higher in either group. The risk of mom getting an infection (chorioamnionitis) was slightly highly in the watch-and-wait group. These results were consistent with prior research.

The authors conclude that  “in pregnancies complicated by [preterm prelabor rupture of the membranes] between 34 and 37 wk of gestation the incidence of neonatal sepsis is low. Neither our trial nor the updated meta-analysis shows that [induction of labor] substantially improves pregnancy outcomes compared with [expectant management].”

They also note that the results of this study apply to circumstances “at least the Dutch/Western European population” but not “low-income countries” where antibiotics may not be available.

 

Photo Credit: Cuba Galleries/Flickr

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