‘Watch-and-Wait’ Approach Best When Water Breaks Before Labor: Study

TUESDAY, April 24 (HealthDay News) — Rather than induce labor,
pregnant women whose water breaks early may fare just as well if they are
closely monitored by medical staff, a new study indicates.

Dutch researchers found this “watch-and-wait” approach to preterm,
pre-labor rupture of the membranes does not significantly raise risks for
women or their babies.

Still, experts commenting on the findings said the study may not be the
last word on the subject, and many obstetricians may still advise induced
labor in these circumstances.

In the study, researchers tracked outcomes for 500 women who
experienced pre-labor rupture of the membranes between 34 and 37 weeks
gestation (40 weeks is considered full-term). The women were randomly
divided into two groups: those who were closely monitored and those who
were induced immediately.

The study, published April 24 in the journal PLoS Medicine,
revealed there was no significant difference in the number of babies born
with blood infections or lung problems between the two groups of women.
The study also found the risk for C-section was similar in both groups.
The researchers noted the risk for maternal infection was slightly lower
among the women who were induced than those who were monitored.

The researchers, led by David van der Ham of Mastricht University
Medical Center, also conducted an analysis of all relevant studies (known
as a “meta-analysis”) on this issue, and came to the same conclusion.

“Neither our trial nor the updated meta-analysis shows that [induction
of labor] substantially improves pregnancy outcomes” compared to the
watch-and-wait strategy, they wrote.

But two experts in the United States said more study may be needed.

“Once ruptured membranes have occured, infection to the mother and the
baby becomes the overreaching factor,” explained Dr. Frederic Gonzalez, an
obstetrician/gynecologist at NYU Langone Medical Center and clinical
associate professor at the NYU School of Medicine, in New York City. “Data
for decades has shown that the incidence of chorioamnionitis [inflammation
of fetal membranes caused by bacterial infection] goes up significantly
after 24 hours.”

According to Gonzalez, in this situation, “the only reason to delay
delivery is early gestational age and the incidence of prematurity related
complications, such as respiratory distress syndrome.” The definition of
early gestational age in this situation “has varied over the years but it
has settled at 34 weeks over the last 13 years or so. Of course, that
gestational age can change as the data changes.”

Gonzale added that the study size is perhaps too small to resolve this
issue, and he pointed out that “even this study shows an increasing
likelihood of infection.”

According to Gonzalez, women in this study who were placed on the
“watch-and-wait” category may have fared well because of antibiotics and
today’s sophisticated neonatal care facilities. But, “the question
becomes, just because you can get away with it, should you try to get away
with it?” he said.

Another ob/gyn agreed that the study had its limitations.

Dr. Jill Rabin, chief of ambulatory care, obstetrics and gynecology,
and head of urogynecology at Long Island Jewish Medical Center in New Hyde
Park, N.Y., noted that while induction of labor “did not statistically
improve neonatal or maternal outcome,” the watch-and-wait approach
“prolonged pregnancy by an average of four days, and it is not known
whether or not this was clinically relevant.”

The study group was also relatively small, she added, and “cultures and
blood samples [were] not taken in each case for complete comparison.”

The Dutch research team also stressed that, due to wide discrepancies
in health care and the availability of antibiotics around the world, their
findings may not extend to low-income countries.

More information

The American Academy of Family Physicians provides more information on

preterm rupture of membranes
.

You can skip to the end and leave a response. Pinging is currently not allowed.

Leave a Reply

Powered by WordPress | Designed by: Premium WordPress Themes | Thanks to Themes Gallery, Bromoney and Wordpress Themes