Premature Rupture of the Membranes at Term: Obstetric Outcome with Oxytocin Stimulation in Relation to Parity and Cervical Dilatation at Admission

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Abstract
The obstetic outcome in women with premature rupture of the membranes (PROM) at term (>36 weeks gestation) without spontaneous onset of labor (within 2 h after admission) was evaluated prospectively in a joint study at the University Hospital of Lund, Sweden and Kandang Kerbau Hospital, National University of Singapore. After 2 h of observation without uterine contractions, labor was stimulated with oxytocin infusion. 303 patients participated and were classified according to parity (nulliparae-multiparae) and cervical dilatation at admission (<2 cm dilated; .gtoreq. 2 cm dilated). No significant race-related differences could be found, except for birthweight. Nulliparae with unfavorable cervix at admission had a high rate of ominous fetal heart rate findings in labor and a high cesarean section rate (19.4%), particularly for failed stimulation of labor. The high cesarean section rate after routine stimulation of labor in nulliparae with unfavorable cervix suggests that a non-intervention approach may be justified in this group. In contrast, the cesarean section rate after stimulation of labor was 3.6% in nulliparae with the cervix dilated 2 cm or more at admission and 4.2% in multiparae and ominous fetal heart rate changes were much less common.