IMMEDIATE INDUCTION AND EXPECTANT MANAGEMENT IN PREMATURE RUPTURE OF MEMBRANES AT 34-36 WEEKS
DOI:
https://doi.org/10.71000/96988503Keywords:
Apgar Score, Birth Weight, Cesarean Section, Induced Labor, NICU Admission, PPROM, , Premature Rupture of Fetal MembranesAbstract
Background: Preterm Premature Rupture of Membranes (PPROM) between 34+0 and 36+6 weeks of gestation presents a significant clinical challenge, as the choice between Immediate Induction of Labor (IoL) and Expectant Management (EM) may impact both maternal and neonatal outcomes. While IoL may reduce the risk of infection, EM allows for spontaneous labor, potentially lowering cesarean rates. However, variations in practice and outcomes necessitate high-quality evidence to guide optimal clinical decision-making.
Objective: To compare maternal and neonatal outcomes between Immediate Induction of Labor and Expectant Management in women with PPROM at 34+0 to 36+6 weeks’ gestation.
Methods: This randomized controlled trial enrolled 313 pregnant women diagnosed with PPROM between 34+0 and 36+6 weeks. Participants were randomly assigned to the IoL group (n=157) or the EM group (n=156). In the IoL group, labor was induced promptly using oxytocin or misoprostol. In the EM group, patients were managed expectantly with regular monitoring until spontaneous labor onset or clinical indication for induction. Primary outcomes included mode of delivery, NICU admissions, and maternal complications. Secondary outcomes assessed were Apgar scores, birth weight, postpartum hemorrhage, postpartum infection, and hospital stay. Statistical analyses included Chi-square and t-tests, with p<0.05 considered significant.
Results: The IoL group had a higher cesarean rate (40%) than the EM group (25%) but lower NICU admission rates (25% vs. 45%). Birth weight was higher in EM (3064.90g) versus IoL (2790.10g), while average Apgar scores were slightly higher in IoL (8.00 vs. 7.95). Postpartum hemorrhage occurred in 10% of IoL and 15% of EM patients. Average hospital stay was shorter in the IoL group (3.80 vs. 4.60 days).
Conclusion: Immediate Induction of Labor in late preterm PPROM may improve short-term neonatal outcomes and reduce maternal infection rates but is associated with a higher risk of cesarean delivery.
References
Garg A, Jaiswal A. Evaluation and Management of Premature Rupture of Membranes: A Review Article. Cureus. 2023;15(3):e36615.
Ozturk Agaoglu M, Turgut E, Agaoglu Z, Tokalioglu EO, Kara O, Tanacan A, et al. Evaluation of fetal cardiac output in preterm premature rupture of membranes. Echocardiography. 2023.
Ronzoni S, Boucoiran I, Yudin MH, Coolen J, Pylypjuk C, Melamed N, et al. Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes. J Obstet Gynaecol Can. 2022;44(11):1193-208.e1.
Valensise H, Pometti F, Farsetti D, Novelli GP, Vasapollo B. Hemodynamic assessment in patients with preterm premature rupture of the membranes (pPROM). Eur J Obstet Gynecol Reprod Biol. 2022;274:1-4.
Wang J, Xu J, Chao B, Liu H, Xie L, Qi H, et al. Hydrogen sulfide inhibits the rupture of fetal membranes throngh anti-aging pathways. Placenta. 2023;143:22-33.
Li H, Hu Z, Fan Y, Hao Y. The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis. BMC Pregnancy Childbirth. 2024;24(1):345.
Freeman SW, Denoble A, Kuller JA, Ellestad S, Dotters-Katz S. Management of Preterm Premature Rupture of Membranes in the Late Preterm Period. Obstet Gynecol Surv. 2022;77(5):283-92.
Maheshwari MV, Khalid N, Patel PD, Alghareeb R, Hussain A. Maternal and Neonatal Outcomes of Adolescent Pregnancy: A Narrative Review. Cureus. 2022;14(6):e25921.
Choltus H, Lavergne M, De Sousa Do Outeiro C, Coste K, Belville C, Blanchon L, et al. Pathophysiological Implication of Pattern Recognition Receptors in Fetal Membranes Rupture: RAGE and NLRP Inflammasome. Biomedicines. 2021;9(9).
Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234. Obstet Gynecol. 2021;138(2):e65-e90.
Karabay G, Bayraktar B, Seyhanli Z, Cakir BT, Aktemur G, Sucu ST, et al. Predictive value of inflammatory markers (NLR, PLR, MLR, SII, SIRI, PIV, IG, and MII) for latency period in Preterm premature rupture of membranes (PPROM) pregnancies. BMC Pregnancy Childbirth. 2024;24(1):564.
Gorczyca K, Kozioł MM, Kimber-Trojnar Ż, Kępa J, Satora M, Rekowska AK, et al. Premature rupture of membranes and changes in the vaginal microbiome - Probiotics. Reprod Biol. 2024;24(3):100899.
Gatta LA, Hughes BL. Premature Rupture of Membranes with Concurrent Viral Infection. Obstet Gynecol Clin North Am. 2020;47(4):605-23.
Dayal S, Jenkins SM, Hong PL. Preterm and Term Prelabor Rupture of Membranes (PPROM and PROM). StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2025, StatPearls Publishing LLC.; 2025.
Rath W, Maul H, Kyvernitakis I, Stelzl P. Preterm Premature Rupture of Membranes - Inpatient Versus Outpatient Management: an Evidence-Based Review. Geburtshilfe Frauenheilkd. 2022;82(4):410-9.
Yang ST, Wang PH. Preterm premature rupture of membranes (PPROM) and secondary intra-amniotic infection/inflammation. Taiwan J Obstet Gynecol. 2023;62(1):187-8.
Tsuda S, Nomiyama M. Reply to "preterm premature rupture of membranes (PPROM) and secondary intra-amniotic infection/inflammation". Taiwan J Obstet Gynecol. 2023;62(1):190.
Lee WL, Chang WH, Wang PH. Risk factors associated with preterm premature rupture of membranes (PPROM). Taiwan J Obstet Gynecol. 2021;60(5):805-6.
Mendez-Figueroa H, Chauhan SP. Tocolytic Therapy in Preterm Premature Rupture of Membranes. Obstet Gynecol Clin North Am. 2020;47(4):569-86.
Tchirikov M, Ocker R, Seliger G, Chaoui K, Moritz S, Haase R. Treatment of mid-trimester preterm premature rupture of membranes (PPROM) with multi-resistant bacteria-colonized anhydramnion with continuous amnioinfusion and meropenem: a case report and literature review. Arch Gynecol Obstet. 2022;306(3):585-92.
Nakanishi K, Yamamoto R, Imanishi Y, Hayashi S, Wada K, Ishii K. Umbilical cord prolapse after preterm premature rupture of membranes. Taiwan J Obstet Gynecol. 2022;61(3):489-93.
Bennett PR, Brown RG, MacIntyre DA. Vaginal Microbiome in Preterm Rupture of Membranes. Obstet Gynecol Clin North Am. 2020;47(4):503-21.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Lubna Tahir (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.