Watch and wait better for women whose water breaks early


Pregnant women whose water breaks late in preterm pregnancy, yet prior to labor, are best managed by monitoring and waiting until they deliver spontaneously. They say this is preferable to having labor induced.

David van der Ham, Maastricht University Medical Center in the Netherlands, conducted a study of more than 500 pregnant women with preterm pre-labor rupture of the membranes at 34 to 37 weeks of gestation. This refers to women who water broke late in preterm pregnancy but labor does not begin. These women either had labor induced immediately or were monitored and waited for spontaneous delivery.

Between the two groups there was no statistically important difference in the number of infants born with blood infections or those who had respiratory distress syndrome. Cesarean births ranked similarly amongst both groups. However, the risk of maternal infection, chorioamnionitis, was marginally lower in the group of women who were induced.

“We conclude that in pregnancies complicated by [preterm prelabor rupture of the membranes] between 34 and 37 wk of gestation the incidence of neonatal sepsis is low. Neither our trial nor the updated meta-analysis shows that [induction of labor] substantially improves pregnancy outcomes compared with [expectant management]. Despite some differences in baseline characteristics, we assume that the results of our study can be generalized to at least the Dutch/Western European population,” stated the report.

“Because of wide differences in general health care and availability of antibiotics, it is likely that these results cannot be generalized to low-income countries,” the report underscored.

Source: MedicalNewsToday, PLoS Medicine


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