Timing of Labor Induction and Its Effects on Maternal and Neonatal Outcomes

About half of the women with prelabor rupture of membrane (PROM) experience spontaneous labor following induction of labor at 24 hours compared to 12 hours. But they were at higher risk of chorioamnionitis, suggests a retrospective study published in the American Journal of Obstetrics & Gynecology.¹

This study was conducted at a single tertiary center between 2020 and 2023 to investigate the maternal and neonatal morbidity outcomes between induction of labor at 12 hours in 802 women vs 24 hours in 962 women following PROM. Women presenting with complications necessitating immediate delivery and multiple pregnancies were excluded from the study group. The study protocol was updated on July 1, 2021 to extend the conservative management duration by administering oxytocin after 24 hours instead of 12 hours post PROM. The rate of chorioamnionitis was compared between two induction protocols for women at term with PROM and who did not show signs of active labor upon admission.

Several differences were observed between the two groups. Half of the women (50.4%) in the 24-hour protocol group experienced spontaneous labor compared to the 12-hour protocol group (41.5%).They also had a higher rate of chorioamnionitis (7.5% vs. 4.7%). Cesarean deliveries occurred at similar rates between the two groups (16.3% vs 17%).

A higher percentage of neonates born after the 24-hour protocol required intensive care with neonatal intensive care unit admission rate of 6.2% vs 3.6% in the 12-hour protocol group. They also required more antibiotics 5.7% vs. 2.9%) and also experienced respiratory distress (4.2% vs. 1.0%).

In the study, it was observed that among women with a previous vaginal delivery, the rate of inductions was lower following the 24-hour protocol compared to the 12-hour protocol (46.5% vs. 57.3%). However, maternal and neonatal outcomes were found to be similar between the two groups. On the other hand, among women with a previous cesarean delivery, the rates were lower following the 24-hour protocol compared to the 12-hour protocol, for oxytocin use (20.3% vs 43.2%) and cesarean delivery (28.9% vs 48.6%).

These findings suggest potential differences in induction practices and maternal and neonatal outcomes based on previous delivery history. These have potential implications for the management of term PROM. Hence, “shared decision-making” is crucial in the management of term PROM, state the authors. Women should be informed about the lower chance for induction and the higher risk of chorioamnionitis associated with the 24-hour induction protocol. They further suggest that parous women and those with a history of previous cesarean delivery may benefit from longer expectant management. Hence, past delivery history must be taken into consideration when making management decisions for term PROM.

Reference

 Am J Obstet Gynecol. 2024 Jan.;230(1 Suppl):S71. DOI:https://doi.org/10.1016/j.ajog.2023.11.122.