Dutch researchers report in a study published in PLoS Medicine that pregnant women whose waters break late in preterm pregnancy, yet prior to labor, are best managed by monitoring and waiting until they deliver spontaneously instead of having their labor induced.
David van der Ham, from the Maastricht University Medical Center in the Netherlands, and his team conducted a study in more than 500 pregnant women with preterm pre-labor rupture of the membranes between 34 and 37 weeks of gestation, i.e. whose water broke late in preterm pregnancy, yet before they went into labor, to either having their labor induced immediately or undergo expectant management, i.e. being monitored and waited until they delivered spontaneously.
The researchers observed that between both groups, there was no statistically important difference in the number of infants with neonatal sepsis (blood infection) or those who developed respiratory distress syndrome, i.e. problems in breathing, and that Cesarean section rates were also comparable amongst both groups. However, the risk of maternal infection (chorioamnionitis) was marginally lower in the group of women whose labor was induced, as compared with those in the expectant management group. The results proved consistent with the researchers meta-analysis.
They conclude:
“We conclude that in pregnancies complicated by [preterm prelabor rupture of the membranes] between 34 and 37 wk of gestation the incidence of neonatal sepsis is low. Neither our trial nor the updated meta-analysis shows that [induction of labor] substantially improves pregnancy outcomes compared with [expectant management]. Despite some differences in baseline characteristics, we assume that the results of our study can be generalized to at least the Dutch/Western European population.”
They underline though, that: “Because of wide differences in general health care and availability of antibiotics, it is likely that these results cannot be generalized to low-income countries.”
Written By Petra Rattue