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Volume 334:1005-1010 April 18, 1996 Number 16 Next

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ABSTRACT

Background As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing labor will reduce this risk or whether one method of induction is better than another.

Methods We studied 5041 women with prelabor rupture of the membranes at term. The women were randomly assigned to induction of labor with intravenous oxytocin; induction of labor with vaginal prostaglandin E₂ gel; or expectant management for up to four days, with labor induced with either intravenous oxytocin or vaginal prostaglandin E₂ gel if complications developed. The primary outcome was neonatal infection. Secondary outcomes were the need for cesarean section and women's evaluations of their treatment.

Results The rates of neonatal infection and cesarean section were not significantly different among the study groups. The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group, 3.0 percent for the induction-with-prostaglandin group, 2.8 percent for the expectant-management (oxytocin) group, and 2.7 percent for the expectant-management (prostaglandin) group. The rates of cesarean section ranged from 9.6 to 10.9 percent. Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management (oxytocin) group (4.0 percent vs. 8.6 percent, P<0.001), as was postpartum fever (1.9 percent vs. 3.6 percent, P = 0.008). Women in the induction groups were less likely to say they liked "nothing" about their treatment than those in the expectant-management groups.

Conclusions In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E₂ and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

Source Information

From the Department of Obstetrics and Gynaecology (M.E.H., D.F.), the Department of Paediatrics (A.O., E.E.L.W.), and the Faculty of Nursing (E.D.H.), University of Toronto, Toronto; the University of Toronto Perinatal Clinical Epidemiology Unit at Women's College Hospital, Toronto (M.E.H., A.O., S.A.H., E.D.H., T.L.M., J.A.W., A.R.W.); and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. (M.E.H., A.R.W.).

Address reprint requests to Dr. Hannah at the University of Toronto Perinatal Clinical Epidemiology Unit, Women's College Hospital, Suite 751, 790 Bay St., Toronto, ON M5G 1N8, Canada.

Full Text of this Article

Related Letters:

Prelabor Rupture of the Membranes at Term
Ennis M. C., Geary M. P., Morrison J. J., Ecker J. L., Kilpatrick S. J., Hannah M. E., Duff P.
Extract | Full Text  
N Engl J Med 1996; 335:1156-1159, Oct 10, 1996. Correspondence

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