Induction of Labor After Premature Rupture of Membranes May Not Reduce Risk of InfectionDevan McGuinness
Findings in a new study were presented on February 9th at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting , in Dallas, Texas indicated that induction of labor for women who have premature rupture of membranes between 34-37 weeks does not reduce the risks of infection or respiratory problems in newborns. The study looked at the risks between induction of labor after premature rupture vs expectant management which involves waiting for a pre-defined amount of time for labour to start on it’s own.
According to a study done by the World Health Organization in 2007, premature rupture of membranes was thought to “have an association with maternal and fetal infection with the risk considered to increase proportionally to the time between membrane rupture and birth,” making this new study an interesting one.
This is the second time performing this study because the first time they studied 532 women using the same methods — the results were lower then they had expected. Given that, they performed a second trial observing 536 women from January 2007 until September 2009, and 195 women from December 2009 until January 2011. Out of those cases, 199 patients were randomized and included in this study.
Women who presented with prolonged (24 hours) premature rupture of membranes between 34-37, patients were allocated to either immediate delivery or expectant management until 37 weeks of gestational age.
The results indicated that :
the risk for neonatal sepsis (infection of the newborn) overall was low (3.6%) and did not differ between treatment strategies; the risk for respiratory distress syndrome (breathing problems of the newborn) did not differ between treatment strategies; and caesarean section rates were equal in both treatment strategies. Combined with results of all previous published trials there was no difference in the identified risks.
The study did note that there was one case of neonatal death in the induced labor group, which was due to severe neonatal blood loss during delivery, but there were no significant differences in other neonatal outcomes. Clinical chorioamnionitis (inflammation of the chorion and the amnion, the membranes that surround the fetus) was seen more often in the expectant management group (4.1%) but all other maternal outcomes and mode of delivery were comparable.
Overall, David van der Ham, MD, with the Maastricht University Medical Center, Obstetrics & Gynecology, GROW School for Oncology and Developmental Biology, Maastricht, Netherlands concludes that their “research indicates that in patients who underwent close monitoring, known as expectant management, versus those whose labor was induced, there was no difference in the risk for infection in the newborn, breathing problems in the newborn or caesarean section rates.”
:: What are your thoughts? If you have premature rupture will you opt for induction or expectant management? ::