Early Rupture of Membranes: Induce or Wait?

In almost 10% of women, membranes rupture before labor begins. There is controversy about whether it is best to induce labor or to wait expectantly. This international study compared maternal and fetal outcomes in 5041 women randomized to induction with IV oxytocin, induction with vaginal prostaglandin E₂ gel, or expectant management for up to four days.

All the women were at term. Rates of neonatal infection, the primary endpoint, were 3% or less in all three management groups and did not differ significantly; cesarean-section rates were approximately 10% in all groups. Clinical chorioamnionitis was less common in women induced with oxytocin than in those managed expectantly (4.0% vs. 8.6%, p<0.001), but was not significantly less common in…