Expectant management in nulliparous term pregnant women with premature rupture of membranes and an unripe cervix

Summary

In total 181 nulliparous term pregnant women with premature rupture of membranes, no uterine contractions and an unripe cervix were allocated at random to labour induction after 12 hours (Group A) or 24 hours (Group B). As long as the cervix remained unfavourable (cervical score ≤5) a pessary containing 3 mg of prostaglandin E₂ was applied vaginally in the posterior fornix every 12 hours starting 12 or 24 hours after premature rupture of membranes. In Group A, 72 (75 per cent) required induction of labour while 46 (50 per cent) in Group B started their labour spontaneously (P < 0.05). The need for prostaglandin E₂ was more frequent in Group A compared with Group B (P < 0.05). The number of instrumental deliveries did not differ. Maternal complications and the neonatal infectious morbidity was the same in the two groups. We conclude that expectant management for 24 hours results in a high incidence of spontaneous ripening of the cervix combined with spontaneous onset of labour with no disadvantage with respect to maternal or fetal infectious morbidity.