The management of women with
spontaneous rupture of membranes at term in the absence of labor and with a cervix unfavorable for
induction of labor is controversial. In this randomized study of 182 patients, we report the effects of delayed versus early
induction of labor on maternal and neonatal outcome. Qualifying patients not in labor at 6 hours after
spontaneous rupture of membranes were randomized to either immediate
oxytocin induction (86 women) or expectant management with
oxytocin induction at 24 hours if labor had not occurred spontaneously (96 women). The
cesarean section rate did not differ between the two groups. Women in the delayed group had significantly longer hospitalization (P less than .003), and their infants were significantly more likely to receive
antibiotics (P = .006). Infectious morbidity (positive cultures or x-ray-documented
pneumonia) occurred in five of the neonates in the delayed group, all of whose mothers had an initial digital cervical examination, but in none of the neonates in the early group, a difference that did not reach statistical significance (P = .061). Five (28%) of 18 infants from the delayed group whose mothers had received an initial digital cervical examination became infected, compared with none of the 78 infants from the delayed group whose mothers did not have digital examinations (P less than .001). We conclude that there is no advantage to delaying
induction of labor when women present at term with
spontaneous rupture of membranes.