[Premature rupture of fetal membranes near term: wait it out or intervene?]

Abstract

In the here presented study we investigated whether it is preferable to wait or to intervene after premature rupture of membranes (PROM) near term (greater than or equal to 36 weeks). In our first approach to answer this question we compared two time periods retrospectively in which we had managed PROM in alternate ways: In 1984 we waited 12 hours for spontaneous start of labor. After 12 hours we induced labor by Oxytocin infusion. In 1986 and 1987 we applicated 0.4 mg Prostaglandin E2 (PGE2) intracervically instead of iv Oxytocin. 67 patients received PGE2 within 6 hours, 63 patients within 7-12 hours after PROM. In total we included 416 patients into this study. We were able to show that intracervical PGE2 gel gave unambiguously better results both for primiparae and multiparae. We observed the least complications with early (less than or equal to 6 h after PROM) application of PGE2 gel. The following parameters favoured early PGE2 application significantly (p less than 0.01): interval PROM - delivery, duration of labor, incidence of cesarean sections, morbidity rate of mother and child. In our second approach we were able to confirm our results in a randomised prospective study, in which we looked at 57 women with PROM in early 1988. Additionally a direct correlation of time between PROM and birth and rate of maternal or neonatal infection emerged: We saw the best results, if labor started within 6 hours after PROM. The rate of cesarean sections and newborns that had to be transferred to pediatrics had doubled within 7-12 hours and more than quadrupled after 12 hours.(ABSTRACT TRUNCATED AT 250 WORDS)