Early planned labor induction vs expectant management in late preterm pre-labor rupture of membranes: maternal and neonatal outcomes

Objectives: To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM). Material and methods: A retrospective file review was conducted in a single tertiary center from January 2015 to September 2019. Singleton pregnancies complicated by late PPROM at 34–36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction. Results: We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant management group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively). Conclusions: In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expectant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM.