[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Timing of Labor Induction].

To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes. We searched Medline Database, Cochrane Library and consulted international guidelines. In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96hours, followed by induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days. In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women's preference after having informed them of the risks and benefits associated with induction and expectant management (Professional consensus). In case of meconial fluid or term prelabor rupture of membranes>4 days, induction must be offered (Professional consensus).

Sibiude J 《-》

[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Short Text].

To determine the management of patients with term prelabor rupture of membranes. Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges. Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity. Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).

Senat MV ，Schmitz T ，Bouchghoul H ，Diguisto C ，Girault A ，Paysant S ，Sibiude J ，Lassel L ，Sentilhes L ... -  《-》

[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Methods for Inducing Labor].

To assess the studies comparing induction methods in women with term prelabor rupture of the membranes and establish if one is superior to the others. The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. The included studies compared medical induction methods: oxytocin (intravenous), dinoprostone (vaginal gel, pessary or intracervical gel), and misoprostol (oral or vaginal route); and a mechanical induction method: the Foley catheter. The primary outcome measures were: labor induction to delivery interval, number of women delivered within 12 or 24hours of initiation of induction and cesarean delivery rate. The small sample size of the included studies as well as the limited number of reported complications does not provide a reasonable basis for concluding on the secondary outcome measures: pyrexia, chorioamnionitis, uterine tachysystole, Apgar scores of<7 at 5minutes. Induction of labor with misoprostol (oral and vaginal) reduced the labor induction to delivery interval compared with dinoprostone (LE2). This interval was unchanged when comparing induction with oxytocin and Foley catheter (LE2). The data comparing this interval in women induced with dinoprostone versus oxytocin and misoprostol versus oxytocin is limited or inconsistent. The cesarean delivery rate was comparable in women induced with dinoprostone (vaginal gel) versus oxytocin (LE2), misoprostol (oral and vaginal route) versus oxytocin (LE2), Foley catheter versus oxytocin (LE2), misoprostol versus dinoprostone (LE2) and misoprostol versus Foley catheter (LE2). The number of women delivered within 24hours of initiation of induction was comparable when induced with oral misoprostol versus oxytocin (LE2) and Foley catheter versus oxytocin (LE2). There is a lack of data for this outcome when comparing dinoprostone versus oxytocin, vaginal misoprotsol versus oxytocin, and misoprostol (oral and vaginal) versus dinoprostone. No induction method is superior to another for nulliparous women or women with unfavorable cervix (LE2). The superiority of an induction method, in terms of effectiveness or safety, could not be established with the current available data for women with term prelabor rupture of the membranes. An increased risk of chorioamnionitis due to induction using Foley catheter could not be ruled out by the available data. All medical methods are suitable for inducing women with term prelabor rupture of the membranes (Grade B).

Girault A 《-》

Term prelabor rupture of membranes: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).

Sénat MV ，Schmitz T ，Bouchghoul H ，Diguisto C ，Girault A ，Paysant S ，Sibiude J ，Lassel L ，Sentilhes L ... -  《-》

[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Initial Management].

To evaluate safety of home care, clinical and biological initial examination and effectiveness of prophylactic antibiotic in preventing maternal and neonatal infectious complications in women with term prelabor rupture of membranes. The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. In case of expectant management and low rate of antibiotic prophylaxis coverage, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially when colonized with Group B Streptococcus (GBS) (LE3). Home care is therefore not recommended (Grade C). Studies investigating the initial clinical-biological examination are sparse. The initial examination should search for signs of intra-uterine infection. Repeated digital examination before and during labor is associated with an increased risk of intra-uterine infection (LE3). It is therefore recommended to limit the number of digital examinations before and during labor (Grade C). A GBS-positive vaginal swab is strongly associated with the risk of intra-uterine and neonatal infection (LE3) independently of the type management (induction vs. expectant management) and the mode of induction (oxytocin or prostaglandin) (LE3). When the GBS-positive vaginal swab has not been performed between 34 and 38 weeks, it is recommended to perform it on admission (Professional consensus). The diagnostic performance of the CRP and white blood cell count for the prediction of neonatal infection is low (LE3). If these tests are used, the negative predictive value of the CRP should be preferred (Professional consensus). In case of term prelabor rupture of membranes after 12hours, prophylactic antibiotics could reduce the rate of intra-uterine infection without reducing the risk of neonatal infection (LE3). Their use in term prelabor rupture of membranes after 12hours is therefore recommended (Grade C). When prophylactic antibiotics are indicated, intravenous beta-lactamine is the preferred option (Grade C). Overall, the current data on initial management of term prelabor rupture of membranes are of low evidence level.

Bouchghoul H 《-》