The Optimal Induction Timing In Prelabor Rupture of Membranes: A Retrospective Study

Abstract Objective: Term prelabor rupture of membrane (PROM) occurs in 8% of term deliveries, but it is unclear when to initiate induction. Our objective was to assess the optimal timing of oxytocin induction in management of term PROM in terms of maternal and neonatal outcomes.Methods: A retrospective cohort at a single tertiary care center from 2010 to 2020. All singleton pregnancies with PROM beyond 37 weeks gestation, without regular uterine contractions, were included. Eligible women were divided into three groups according to the timing of oxytocin induction (<12; 12-24; >24 hours) following PROM. Results: Of 9,443 women presented with term PROM, of them 1676 were included. They were classified according timing of oxytocin induction initiation following PROM: 1,127 within 12 hours; 285 within 12-24 hours; 264 after 24 hours. There were no significant differences in baseline demographic characteristics between groups. Women who were early induced delivered significantly sooner than those who received oxytocin later (45 vs. 28.2 vs. 23.2 hours, respectively, p<0.001. Maternal infection rate was similar and unrelated to oxytocin starting time. Their babies were less likely to receive antibiotics (26.8% vs. 38.6% vs. 33.33%, respectively; p<0.001), and they had lower rates of composite adverse neonatal outcome (RR=1.27, p=0.0307). Conclusion: In term PROM, early induction (within 12 hours of PROM) may be recommended to reduce time-do-delivery interval and increase delivery rate within 24 hours. It may be of economic significance and improve women satisfaction. Furthermore, early induction may also improve neonatal outcomes, without worsening maternal outcomes.