Women with prelabor rupture of membranes at term are best managed by immediate induction of labor, according to a secondary analysis of data from the multicenter Term Prelabor Rupture of the Membranes (TermPROM) study published in the American Journal of Obstetrics and Gynecology.¹

The TermPROM study had compared immediate delivery by induction of labor against expectant management i.e., waiting for spontaneous onset of labor in the absence of feto-maternal compromise in women with prelabor rupture of membranes at term (≥37 weeks of gestation). The present study evaluated the outcomes of labor induction and expectant management after term prelabor rupture of membranes within the first 36 hours to determine the optimal timing of labor induction. Out of the 4742 study participants enrolled, 2622 underwent labor induction, while the remaining 2120 had a spontaneous onset of labor.

An increasing incidence of neonates requiring admissions to intensive care units and neonatal infections including maternal infections (clinical chorioamnionitis or postpartum fever) were observed with time after PROM at term. Women who underwent labor induction were less prone to these adverse outcomes compared to those who underwent expectant management within the first 15-20 hours after PROM without affecting the risk for cesarean delivery. Compared to the expectant management group, women in whom labor was induced within the first 30 to 36 hours had a shorter time to delivery following PROM; they also had a shorter duration of hospitalization. Out of the 2120 women in the expectant management group, 1365 (64%) had spontaneous onset of labor within the first 24 hours after PROM.

This study has established the optimal timing of induction of labor. Given the low incidence of adverse maternal and neonatal outcomes, it shows immediate induction of labor as the best management option in women with PROM at term. However, if immediate induction of labor is not feasible, then it should still be the preferred option and done within the first 15 to 20 hours after prelabor rupture of membranes.

Reference

1. Melamed N, et al. Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM study. Am J Obstet Gynecol. 2023 Mar;228(3):326.e1-326.e13. doi: 10.1016/j.ajog.2022.09.018.