Controversies: prelabor rupture of the membranes at term: the case for expectant management

Review of the controlled comparisons between induction of labor and expectant care after prelabor rupture of the membranes (PROM) at term indicates that they are not unhelpful for deciding which of the two options is best. This is, first, because there is a large potential for bias in the studies reported thus far. Second, the trials are rather heterogeneous and they are comparisons more between early and late induction than between induction and expectant care. Third, it is difficult to weigh an increased risk of operative delivery with the induction policy against an apparently clear, but almost certainly biased, reduction of neonatal infection. With expectant care about 70% of women will give birth within 24 hours and 85% within 48 hours. The majority of these women will derive little, if any, benefit from induction and a routine policy of induction of labor after PROM cannot be justified on the basis of the data that are available.