Background

In the case of prelabor rupture of membranes at term, the risk for neonatal and maternal infectious morbidity increases progressively with time from prelabor rupture of membranes. Although most studies identified a benefit associated with early induction within the first 24 hours following term prelabor rupture of membranes, there is currently no precise data regarding how early should induction be scheduled.

Objective

This study aimed to identify the optimal timing of labor induction among women with term prelabor rupture of membranes by comparing the maternal and neonatal outcomes associated with labor induction with those of expectant management at any given 1-hour interval following prelabor rupture of membranes.

Study Design

This was a secondary analysis of data from the TERMPROM trial, an international, multicenter, randomized clinical trial on immediate delivery vs expectant management of women with prelaor rupture of membranes at term (≥37+0/7 weeks’ gestation). We considered all participants as a single cohort of women with term prelabor rupture of membranes, irrespective of the original randomized study group allocation. For each given 1-hour time interval within the first 36 hours following prelabor rupture of membranes, we compared the outcomes of subjects for whom labor induction was initiated during this interval with those of subjects managed expectantly at the same time interval. The primary neonatal outcome was a composite of neonatal infection and admission to the neonatal intensive care unit. The primary maternal outcomes included maternal infection (clinical chorioamnionitis or postpartum fever) and cesarean delivery.

Results

Of the 4742 subjects who met the study criteria, 2622 underwent labor induction, and 2120 experienced a spontaneous onset of labor. The rates of the neonatal composite outcome, neonatal admission to intensive care unit, and maternal infection increased progressively with time after prelabor rupture of membranes. The risk for these outcomes was lower among women who underwent induction when compared with those managed expectantly within the first 15 to 20 hours after prelabor rupture of membranes without affecting the risk for cesarean delivery. In addition, women who underwent labor induction within the first 30 to 36 hours had a shorter prelabor rupture of membranes to delivery time and a shorter total maternal hospital stay when compared with those managed expectantly at the same time interval. Among women managed expectantly, less than two-thirds (64%; 1365/2120) experienced a spontaneous onset of labor within the first 24 hours following prelabor rupture of membranes.

Conclusion

These findings suggest that immediate labor induction seems to be the optimal management strategy to minimize neonatal and maternal morbidity in the setting of prelabor rupture of membranes at term gestations. In cases for which immediate induction is not feasible, labor induction remains the preferred option over expectant management if performed within the first 15 to 20 hours after prelabor rupture of membranes.

中文翻译：

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足月产前胎膜破裂后引产的最佳时机：TERMPROM 研究的二次分析

背景

在足月产前胎膜破裂的情况下，新生儿和产妇感染发病的风险随着产前胎膜破裂的时间逐渐增加。尽管大多数研究发现足月产前胎膜破裂后 24 小时内早期引产具有益处，但目前尚无关于应提前多长时间安排引产的准确数据。

客观的

本研究旨在通过比较与引产相关的孕产妇和新生儿结局与在产前胎膜破裂后任何给定的 1 小时间隔内的期待治疗的结果，确定足月产前胎膜破裂妇女的最佳引产时机。

学习规划

这是对 TERMPROM 试验数据的二次分析，该试验是一项国际、多中心、随机临床试验，针对足月胎膜早破（妊娠≥37+0/7 周）的妇女的立即分娩与期待治疗进行比较。我们将所有参与者视为足月前胎膜破裂女性的单一队列，无论最初的随机研究组分配如何。对于产前胎膜破裂后前 36 小时内每个给定的 1 小时时间间隔，我们将在此间隔期间开始引产的受试者的结果与在同一时间间隔内进行期待管理的受试者的结果进行比较。主要新生儿结局是新生儿感染和入住新生儿重症监护室的综合结果。主要产妇结局包括产妇感染（临床绒毛膜羊膜炎或产后发热）和剖宫产。

结果

在符合研究标准的 4742 名受试者中，2622 名接受了引产，2120 名经历了自然分娩。产前破膜后，新生儿综合结局、新生儿入住重症监护室和孕产妇感染率随着时间的推移逐渐增加。与产前胎膜破裂后 15 至 20 小时内接受引产的女性相比，接受引产的女性出现这些结果的风险较低，且不影响剖宫产的风险。此外，与在相同时间间隔内接受引产的妇女相比，在前 30 至 36 小时内接受引产的妇女的产前胎膜破裂到分娩的时间更短，产妇总住院时间也更短。在按预期管理的女性中，不到三分之二（64%；1365/2120）在产前胎膜破裂后的最初 24 小时内经历了自然分娩。

结论

这些发现表明，在足月妊娠产前胎膜破裂的情况下，立即引产似乎是最大程度地减少新生儿和产妇发病率的最佳管理策略。在无法立即引产的情况下，如果在产前胎膜破裂后 15 至 20 小时内进行引产，那么引产仍然是优于期待治疗的首选。