'Watch-and-Wait' Approach Best When Water Breaks Before Labor: Study
But two experts questioned that conclusion, saying more research may be needed
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Tuesday, April 24, 2012
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 needed.
"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 relevant."
The study group was also relatively small, she added, and "cultures and blood samples [were] not taken in each case for complete comparison."
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 countries.
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