Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)

Some evidence in favour of planned management (usually by induction) when women have prelabour rupture of membranes at term.

When women's membranes rupture at or after 37 weeks' gestation without having contractions, they can choose to intervene (usually by immediate induction with oxytocin or prostaglandin) or they can wait for spontaneous labour to occur. The concern that early planned intervention might result in more caesarean and operative births was not supported in this review, which also found that fewer mothers developed infections and that fewer babies were admitted to the neonatal intensive care units than if women waited for spontaneous birth. Similar number of babies developed infections whether intervention was early or whether women waited. In one trial, women clearly preferred early planned intervention.

Authors' conclusions: 

Planned management (with methods such as oxytocin or prostaglandin) reduces the risk of some maternal infectious morbidity without increasing caesarean sections and operative vaginal births. Fewer infants went to neonatal intensive care under planned management although no differences were seen in neonatal infection rates. Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices.

Read the full abstract...
Background: 

Prelabour rupture of membranes at term is managed expectantly or by elective birth, but it is not clear if waiting for birth to occur spontaneously is better than intervening.

Objectives: 

To assess the effects of planned early birth versus expectant management for women with term prelabour rupture of membranes on fetal, infant and maternal wellbeing.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2004), MEDLINE (1966 to November 2004) and EMBASE (1974 to November 2004).

Selection criteria: 

Randomised or quasi-randomised trials of planned early birth compared with expectant management in women with prelabour rupture of membranes at 37 weeks' gestation or more.

Data collection and analysis: 

Two review authors independently applied eligibility criteria, assessed trial quality and extracted data. A random-effects model was used.

Main results: 

Twelve trials (total of 6814 women) were included. Planned management was generally induction with oxytocin or prostaglandin, with one trial using homoeopathic caulophyllum. Overall, no differences were detected for mode of birth between planned and expectant groups: relative risk (RR) of caesarean section 0.94, 95% confidence interval (CI) 0.82 to 1.08 (12 trials, 6814 women); RR of operative vaginal birth 0.98, 95% 0.84 to 1.16 (7 trials, 5511 women). Significantly fewer women in the planned compared with expectant management groups had chorioamnionitis (RR 0.74, 95% CI 0.56 to 0.97; 9 trials, 6611 women) or endometritis (RR 0.30, 95% CI 0.12 to 0.74; 4 trials, 445 women). No difference was seen for neonatal infection (RR 0.83, 95% CI 0.61 to 1.12; 9 trials, 6406 infants). However, fewer infants under planned management went to neonatal intensive or special care compared with expectant management (RR 0.72, 95% CI 0.57 to 0.92, number needed to treat 20; 5 trials, 5679 infants). In a single trial, significantly more women with planned management viewed their care more positively than those expectantly managed (RR of "nothing liked" 0.45, 95% CI 0.37 to 0.54; 5031 women).