-- Mary Elizabeth Dallas
TUESDAY, April 24 (HealthDay News) -- Rather than induce labor,
pregnant women whose water breaks early may fare just as well if
they are closely monitored by medical staff, a new study
Dutch researchers found this "watch-and-wait" approach to
preterm, pre-labor rupture of the membranes does not significantly
raise risks for women or their babies.
Still, experts commenting on the findings said the study may not
be the last word on the subject, and many obstetricians may still
advise induced labor in these circumstances.
In the study, researchers tracked outcomes for 500 women who
experienced pre-labor rupture of the membranes between 34 and 37
weeks gestation (40 weeks is considered full-term). The women were
randomly divided into two groups: those who were closely monitored
and those who were induced immediately.
The study, published April 24 in the journal
PLoS Medicine, revealed there was no significant difference in the number of babies born with blood infections or lung problems between the two groups of women. The study also found the risk for C-section was similar in both groups. The researchers noted the risk for maternal infection was slightly lower among the women who were induced than those who were monitored.
The researchers, led by David van der Ham of Mastricht
University Medical Center, also conducted an analysis of all
relevant studies (known as a "meta-analysis") on this issue, and
came to the same conclusion.
"Neither our trial nor the updated meta-analysis shows that [induction of labor] substantially improves pregnancy outcomes" compared to the watch-and-wait strategy, they wrote.
But two experts in the United States said more study may be
"Once ruptured membranes have occured, infection to the mother and the baby becomes the overreaching factor," explained Dr. Frederic Gonzalez, an obstetrician/gynecologist at NYU Langone Medical Center and clinical associate professor at the NYU School of Medicine, in New York City. "Data for decades has shown that the incidence of chorioamnionitis [inflammation of fetal membranes caused by bacterial infection] goes up significantly after 24 hours."
According to Gonzalez, in this situation, "the only reason to
delay delivery is early gestational age and the incidence of
prematurity related complications, such as respiratory distress
syndrome." The definition of early gestational age in this
situation "has varied over the years but it has settled at 34 weeks
over the last 13 years or so. Of course, that gestational age can
change as the data changes."
Gonzale added that the study size is perhaps too small to
resolve this issue, and he pointed out that "even this study shows
an increasing likelihood of infection."
According to Gonzalez, women in this study who were placed on
the "watch-and-wait" category may have fared well because of
antibiotics and today's sophisticated neonatal care facilities.
But, "the question becomes, just because you can get away with it,
should you try to get away with it?" he said.
Another ob/gyn agreed that the study had its limitations.
Dr. Jill Rabin, chief of ambulatory care, obstetrics and
gynecology, and head of urogynecology at Long Island Jewish Medical
Center in New Hyde Park, N.Y., noted that while induction of labor
"did not statistically improve neonatal or maternal outcome," the
watch-and-wait approach "prolonged pregnancy by an average of four
days, and it is not known whether or not this was clinically
The study group was also relatively small, she added, and
"cultures and blood samples [were] not taken in each case for
The Dutch research team also stressed that, due to wide
discrepancies in health care and the availability of antibiotics
around the world, their findings may not extend to low-income
The American Academy of Family Physicians provides more
preterm rupture of membranes.
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