Background
In the case of prelabor rupture of membranes at term, the risk for neonatal and maternal
infectious morbidity increases progressively with time from prelabor rupture of membranes.
Although most studies identified a benefit associated with early induction within
the first 24 hours following term prelabor rupture of membranes, there is currently
no precise data regarding how early should induction be scheduled.
Objective
This study aimed to identify the optimal timing of labor induction among women with
term prelabor rupture of membranes by comparing the maternal and neonatal outcomes
associated with labor induction with those of expectant management at any given 1-hour
interval following prelabor rupture of membranes.
Study Design
This was a secondary analysis of data from the TERMPROM trial, an international, multicenter,
randomized clinical trial on immediate delivery vs expectant management of women with
prelaor rupture of membranes at term (≥37+0/7 weeks’ gestation). We considered all
participants as a single cohort of women with term prelabor rupture of membranes,
irrespective of the original randomized study group allocation. For each given 1-hour
time interval within the first 36 hours following prelabor rupture of membranes, we
compared the outcomes of subjects for whom labor induction was initiated during this
interval with those of subjects managed expectantly at the same time interval. The
primary neonatal outcome was a composite of neonatal infection and admission to the
neonatal intensive care unit. The primary maternal outcomes included maternal infection
(clinical chorioamnionitis or postpartum fever) and cesarean delivery.
Results
Of the 4742 subjects who met the study criteria, 2622 underwent labor induction, and
2120 experienced a spontaneous onset of labor. The rates of the neonatal composite
outcome, neonatal admission to intensive care unit, and maternal infection increased
progressively with time after prelabor rupture of membranes. The risk for these outcomes
was lower among women who underwent induction when compared with those managed expectantly
within the first 15 to 20 hours after prelabor rupture of membranes without affecting
the risk for cesarean delivery. In addition, women who underwent labor induction within
the first 30 to 36 hours had a shorter prelabor rupture of membranes to delivery time
and a shorter total maternal hospital stay when compared with those managed expectantly
at the same time interval. Among women managed expectantly, less than two-thirds (64%;
1365/2120) experienced a spontaneous onset of labor within the first 24 hours following
prelabor rupture of membranes.
Conclusion
These findings suggest that immediate labor induction seems to be the optimal management
strategy to minimize neonatal and maternal morbidity in the setting of prelabor rupture
of membranes at term gestations. In cases for which immediate induction is not feasible,
labor induction remains the preferred option over expectant management if performed
within the first 15 to 20 hours after prelabor rupture of membranes.
Key words
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Article info
Publication history
Published online: September 14, 2022
Accepted:
September 12,
2022
Received in revised form:
September 10,
2022
Received:
June 8,
2022
Footnotes
The authors report no conflict of interest.
N.M. holds the Waugh Family Chair in Twin Fetal Medicine Research at the Sunnybrook Health Sciences Center and the University of Toronto, Canada.
Cite this as: Melamed N, Berghella V, Ananth CV, 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;228:326.e1-13.
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