Management of term patients with premature rupture of membranes and an unfavorable cervix.

The purpose of this prospective investigation was to evaluate a protocol for management of term patients with premature rupture of membranes (PROM) and a cervix unfavorable for induction of labor (Bishop score 4 or less). Patients initially were observed for 24 to 36 hours for the spontaneous onset of labor. If spontaneous contractions did not commence, labor was induced with oxytocin. Patients subsequently were divided into three groups: 44 who had spontaneous labor, 29 who had spontaneous labor but required oxytocin augmentation, and 39 women who had oxytocin induction. Patients who entered labor spontaneously had a significantly shorter mean latent period between rupture of membranes and onset of labor (16.0 versus 26.8 and 40.7 hours), shorter mean duration of labor (7.6 versus 12.1 and 13.1 hours), and shorter mean duration of rupture of membranes (23.6 versus 39.0 and 53.8 hours). These women also had a significant decrease in the frequency of chorioamnionitis (7 versus 14 and 33%), and their infants had fewer evaluations for sepsis (25.0 versus 34.5 and 53.8%). We conclude that term patients with PROM and an unfavorable cervix who require oxytocin augmentation or induction of labor are at increased risk for intrapartum and neonatal infection compared with those who progress through labor spontaneously.