MANAGEMENT OF PRELABOR RUPTURE OF THE MEMBRANES IN TERM PRIMIGRAVIDAE - REPORT OF A RANDOMIZED PROSPECTIVE TRIAL

Objective To compare a conservative and an active policy (immediate oxytocin infusion) of management of prelabour rupture of the membranes in term primigravidae. Design Randomized trial involving 444 women. Setting District maternity hospital. Main outcome measures Caesarean section rate in each group; also the rate of forceps deliveries, spontaneous deliveries, length of labour, number of vaginal examinations, type of analgesia, pyrexia in labour or the puerperium and antibiotic use in the mother and the infant in each group. The caesarean section rate for the whole trial where the latent period was > 12 h was compared to that where the latent period was less-than-or-equal-to 12 h. Results There were fewer caesarean sections in the conservative group (odds ratio (OR) 0.60,95% confidence interval (CI) 0.35 to 1.02; P = 0.06). There was a similar number of forceps deliveries (OR 0.79; 95% CI 0.52 to 1.19; P = 0.26) but more spontaneous deliveries (OR 1.57; 95% CI 1.08 to 2.29; P = 0.02) in the conservative group. More women managed conservatively required inhalational analgesia only for pain relief in labour (OR 2.88; 95% CI 1.46 to 5.68; P = 0.003), a similar number required pethidine (OR 1.29; 95% CI 0.85 to 1.94; P = 0.23), and fewer required epi-dural analgesia (OR 0.57; 95% CI 0.39 to 0.84; P = 0.005). The number of vaginal exminations was less in the conservative group (difference between means 0.53; 95% CI 0.25 to 0.80; P<0.001). Fewer women managed conservatively experienced four or more vaginal examinations in labour (OR 0.58; 95% CI 0.39 to 0.86; P = 0.007). There were no differences in the lengths of labour, the proportions of women who developed pyrexia in labour or the puerperium or who required antibiotics or in the proportions of infants who required antibiotics. Conclusions These results argue in favour of a conservative policy in managing primigravidae at term with prelabour rupture of the membranes.