Prelabor Rupture of Membranes at Term: When Should We Recommend Induction? [31R]

INTRODUCTION: Prelabor rupture of membranes (PROM) affects approximately 8% of pregnancies. The TermPROM Study demonstrated that immediate induction of labor (IOL) versus expectant management for up to four days result in similar rates of cesarean and neonatal infection but increased maternal infection. ACOG endorses IOL for PROM but states expectant management may be considered. However, guidelines on the safest duration of expectant management are lacking. This study aims to determine whether there is an optimal time from PROM to IOL initiation. METHODS: This retrospective cohort study included nulliparous women with non-anomalous, singleton, cephalic pregnancies who underwent IOL for PROM at a tertiary-care academic hospital from January 2015 to April 2017. Primary outcome was vaginal delivery (VD) rate. Secondary outcomes were IOL duration, infection, hemorrhage, and NICU admission. The data were analyzed using the Kruskal-Wallis test and logistic regression. RESULTS: The 246 patients were divided into groups by time from PROM to IOL initiation: <12 h (n=116, 47.2%), 12-24 h, (n=96, 39.0%), and >24 h (n=34, 13.8%). There was no difference in VD rate, IOL duration, infection, or NICU admission amongst groups. There was an increased odds of hemorrhage with IOL greater than 24 hours after PROM (aOR 2.74, CI 1.18 - 6.33). There were no differences in NICU admission. CONCLUSION: In this cohort, expectant management up to 24 hours was not associated with increased maternal or fetal risks. Expectant management beyond 24 hours was associated with increased risk of hemorrhage. This suggests that patients with PROM can be safely offered expectant management for up to 24 hours.