[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Definition, Epidemiology, Complications and Risk Factors].

To synthesize current knowledge on definition, frequency, morbidity and risk factors related to term prelabor rupture of membranes. The MedLine database, the Cochrane Library and French and foreign guidelines from 1980 to 2019 have been consulted. Term rupture of membranes is defined by the rupture of the membranes after 37 weeks of gestation (WG). Term prelabor rupture of membranes is defined by the rupture of membranes prior to the onset of labor after 37 WG. According to unpublished data from the 2016 French National Perinatal Survey, 26,5% of women with singleton pregnancies had a term rupture of membranes before their admission into labor ward. We were not able to assess if those were "prelabor" or not (LE3). Among women admitted with term rupture of membranes, 35,6% were still not in labor 12hours after the rupture i.e. 8,9% of all singleton pregnancies (LE3). Reported rates of term prelabor rupture of membranes vary between 6 and 22% in singleton pregnancies (LE3). Term prelabor rupture of membranes is associated with a risk of fever before (LE3), during (LE3) and after labor (LE3), as well as intrauterine and neonatal infection (LE3). The frequency of these complications in the context of a routine antibiotic prophylaxis is unknown. The expert group chose a delay of 12hours without spontaneous labor to differentiate a physiological situation from a potentially risky situation that could justify a medical intervention (Professional consensus). Risk factors for term prelabor rupture of membranes include history of term prelabor rupture of membranes (LE3), nulliparity (LE3), uterine contractions requiring treatment (LE3) and first trimester bleeding (LE3). Data on frequency, risk factors and morbidity of term prelabor rupture of membranes are limited or of poor quality.

Diguisto C 《-》

[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 《-》

[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: 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 - 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 《-》