Management of premature rupture of membranes in term patients: a review of the literature

The question of premature rupture of membranes (PROM) in patients at term gestation has been reopened in the last 10 to 15 years. This thesis is a review of the studies from 1979 to 1990 concerning management of patients with PROM at term. There were 12 relevant studies during this period. Four of the 12 studies met inclusion criteria for statistical comparison and were subjected to a vote-counting procedure. Mean complication rates between induced and expectantly managed (i.e., await spontaneous onset of labor without intervention) patients were not statistically different. The remaining 8 of 12 studies support expectant management if initial vaginal examination is avoided; however, each study had design limitations. Given the historical documentation of maternal and neonatal risk for infection, it is felt that expectant management should be followed only in selective cases. A reasonable, prudent clinical protocol for expectant management is outlined in this thesis. It was the conclusion of this review that more research utilizing larger sample sizes, randomization, and identical diagnostic criteria and management protocols were needed to answer this question conclusively.