[A comparative study of 2 ways of clinical management in premature rupture of the membranes at term: temporization versus labor induction].

Abstract

Two defined management approaches, temporization limited to 48 hours and immediate induction of labor, for premature rupture of the membranes at term were compared in a prospective study between January 1 1991 and November 30 1993 in the Maternity Unit of Yaoundé University Hospital. During this period, 268 cases of premature rupture of the membranes were seen among 3252 deliveries, i.e. an incidence of 8.2%. In the temporization group (153 cases), spontaneous onset of labor was effective in 95 patients (62.1%) within 12 hours and in 137 patients (89.5%) within 24 hours after premature rupture of the membranes. Spontaneous deliveries in this temporization group accounted for 129 cases (92.8%). In the induction of labor group, spontaneous delivery occurred in 119 cases (93.2%). There were ten cesareans in the temporization group and eight cesareans and two vacuum cup extractions in the induction group. Short term (24 hours) prophylactic antibiotics were given to 34 patients, i.e. 16 cases in which the duration of rupture of the membranes was more than 24 hours and 18 cases of cesarean section. Maternal infections concerned 18 cases (6.7%) including 12 cases (4.4%) of malaria. Microbiology of vaginal swabs revealed 6 cases of pseudomonas, 4 cases of staphylococcus aureus and 3 of candida albicans. Neonatal infections confirmed by blood culture and assay of C-reactive-protein involved 24 cases (20.3%). There were three fetal deaths, i.e. perinatal mortality of 1.1%. Risk factors, in these three fetal deaths, included postmaturity (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)