Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Arch Gynecol Obstet. 2024 Sep;310(3):1577-1585. doi: 10.1007/s00404-024-07624-w. Epub 2024 Jul 8.
The optimal labor-induction protocol in women with prelabor rupture of membranes (PROM) is unknown. Whether the management of women with a previous cesarean delivery (CD) with PROM is different remains controversial. We investigated maternal and perinatal outcomes according to two induction protocols of 24 h vs. 12 h.
In July 2021, our protocol of induction of labor in term-PROM was extended from 12 h to 24 h post-PROM. We compared obstetrical and neonatal outcomes before and after the change. A subgroup analysis of women with previous CD was performed. Results were compared using a univariate analysis. A multivariable model was described to predict neonatal intensive care unit admission (NICU) and clinical chorioamnionitis.
The 24 h and 12 h ROM-to-induction protocol groups included 962 and 802 women, respectively. In the 24 h group, a higher proportion of women labored spontaneously (p < 0.001), the rate of chorioamnionitis was higher (p = 0.017), and the CD rate was similar. Admission to the NICU (p = 0.012), antibiotic administration (p = 0.003), and respiratory distress (p = 0.002) were also greater in the 24 h induction group. Among women with a history of CD (n = 143), the need for oxytocin (p = 0.003) and delivery by CD (p = 0.016) were lower in the 24 vs. 12 h group.
Our results advocate shared decision-making in the expectant management of term-PROM. Women should be informed of the lower chance for induction and the higher risk of infections and neonatal complications with a 24-h induction approach. Longer expectant management in women with a previous CD resulted in significantly lower induction and CD rates.
胎膜早破（PROM）孕妇的最佳引产方案尚不清楚。有剖宫产史（CD）的孕妇的管理方法是否不同仍存在争议。我们根据 24 小时与 12 小时的两种引产方案，调查了产妇和围产儿结局。
2021 年 7 月，我们将足月 PROM 引产方案从 12 小时延长至 PROM 后 24 小时。我们比较了改变前后的产科和新生儿结局。对有 CD 病史的妇女进行了亚组分析。使用单变量分析比较结果。描述了多变量模型以预测新生儿重症监护病房（NICU）入住和临床绒毛膜羊膜炎。
24 小时和 12 小时 ROM 至引产方案组分别纳入 962 例和 802 例妇女。在 24 小时组中，自然分娩的比例较高（p<0.001），绒毛膜羊膜炎的发生率较高（p=0.017），剖宫产率相似。NICU 入住（p=0.012）、抗生素使用（p=0.003）和呼吸窘迫（p=0.002）在 24 小时引产组中也更多。在有 CD 病史的妇女（n=143）中，催产素的需求（p=0.003）和剖宫产分娩（p=0.016）在 24 小时组比 12 小时组低。
我们的结果主张在期待治疗足月 PROM 时进行共同决策。应告知妇女，24 小时引产方法的诱导机会较低，感染和新生儿并发症的风险较高。有 CD 病史的妇女进行更长时间的期待治疗，可显著降低诱导和剖宫产率。
