OBJECTIVE: Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity. STUDY DESIGN: Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate. RESULTS: The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection. CONCLUSIONS: Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates.
RCT Entities:
OBJECTIVE: Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity. STUDY DESIGN: Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate. RESULTS: The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection. CONCLUSIONS: Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates.
Authors: Diana M Bond; Philippa Middleton; Kate M Levett; David P van der Ham; Caroline A Crowther; Sarah L Buchanan; Jonathan Morris Journal: Cochrane Database Syst Rev Date: 2017-03-03
Authors: David P van der Ham; Sylvia M C Vijgen; Jan G Nijhuis; Johannes J van Beek; Brent C Opmeer; Antonius L M Mulder; Rob Moonen; Mariët Groenewout; Mariëlle G van Pampus; Gerald D Mantel; Kitty W M Bloemenkamp; Wim J van Wijngaarden; Marko Sikkema; Monique C Haak; Paula J M Pernet; Martina Porath; Jan F M Molkenboer; Simone Kuppens; Anneke Kwee; Michael E Kars; Mallory Woiski; Martin J N Weinans; Hajo I J Wildschut; Bettina M C Akerboom; Ben W J Mol; Christine Willekes Journal: PLoS Med Date: 2012-04-24 Impact factor: 11.069
Authors: Jonathan M Morris; Christine L Roberts; Caroline A Crowther; Sarah L Buchanan; David J Henderson-Smart; Glenn Salkeld Journal: BMC Pregnancy Childbirth Date: 2006-03-23 Impact factor: 3.007
Authors: David P van der Ham; Jan G Nijhuis; Ben Willem J Mol; Johannes J van Beek; Brent C Opmeer; Denise Bijlenga; Mariette Groenewout; Birgit Arabin; Kitty W M Bloemenkamp; Wim J van Wijngaarden; Maurice G A J Wouters; Paula J M Pernet; Martina M Porath; Jan F M Molkenboer; Jan B Derks; Michael M Kars; Hubertina C J Scheepers; Martin J N Weinans; Mallory D Woiski; Hajo I J Wildschut; Christine Willekes Journal: BMC Pregnancy Childbirth Date: 2007-07-06 Impact factor: 3.007