Induction, Expectant Management Equally Safe. (Managing from Patients at Term).

SAN FRANCISCO - It's equally safe to immediately induce labor in a healthy pregnant woman with premature rupture of membranes at term or to manage her expectantly, ideally for no more than 24 hours, Dr. Stephanie E. Mann said.

The cumulative data in the medical literature show that immediate labor induction will not increase the risk for C-section in nulliparous women with premature rupture of membranes (PROM). In addition, the onset of labor within 24 hours of membrane rupture is not associated with increased risk of neonatal infection if the woman is not already infected with group B streptococcus, Dr. Mann said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

Expectant management also will not increase the risk for endometritis. Still, it may be safer to keep these patients hospitalized, because some data suggest that sending them home doubles the risk for neonatal death, added Dr. Mann, director of obstetrics at San Francisco General Hospital.

Some data suggest that women are happier with immediate induction than with several days of expectant management. Given the equivalent safety profiles and the shorter hospital stays with induction compared with expectant management, hospitals and insurance companies are bound to favor induction, she noted. After 37 weeks' gestation the fetal membranes rupture before the onset of labor in about 8% of pregnancies. Spontaneous labor occurs in 85% of women within 24 hours and in 95% of women within 72 hours.

Six studies comparing immediate induction with expectant management showed no difference in the incidence of neonatal sepsis. One of these studies-the 1996 Term PROM trial with 5,042 women-reported neonatal sepsis in 2%-3% of study participants, a finding that spawned half a dozen ...