A systematic review on the management of prelabour rupture of membranes at term

Background:About 10% of women experience pre-labour rupture of membranes at term. The time between the waters breaking and the start of active labour can vary. Two main management options are considered: (1) Inducing labour... [ view full abstract ]

Background:

About 10% of women experience pre-labour rupture of membranes at term. The time between the waters breaking and the start of active labour can vary. Two main management options are considered: (1) Inducing labour after about 24 hours (active management) and (2) Watchful waiting for spontaneous labour while monitoring maternal and baby’s wellbeing (expectant management). There is controversy as to which one is associated with higher rates of normal birth and lower rates of chorioamnionitis (maternal infection) and neonatal infection.

Objective:

This systematic review aims to determine which management is associated with a higher rate of normal birth and lower rates of chorioamnionitis (maternal infection) and neonatal infection for prelabour rupture of membranes in healthy term pregnancies. It also looks at the number of vaginal examinations and their relationship with infection. A systematic review looking at these outcomes, constitute the element of originality of this research.

Methodology:

Key research databases were used. Inclusion criteria were primary quantitative studies comparing the outcomes of active with expectant management in healthy term pregnancies. No limit on the date of publication was set and studies that were published in English, Spanish and French were included. Quality assessment was performed using CASP. The analysis was done narratively due to the high degree of heterogeneity.

Results:

Evidence suggests that the rates of infection in mothers and babies were similar when labour was induced with prostaglandins, compared to when labour was allowed to start spontaneously. There is also evidence to suggest that there is correlation between the number of vaginal examinations and chorioamnionitis.

Discussion and conclusion:

Both expectant and active management appear to be safe options, with vaginal examinations being an important predictor of chorioamnionitis. It is therefore, important to question if a protocol of routine induction of labour at 24 hours is always necessary or beneficial in the absence of other complications.

This presentation will discuss the findings from the systematic review. No ethical issues were identified. No external funding was received. An oral presentation would be preferred.