Features of labor course upon with preterm rupture of membranes and "mature" cervix at gestation of 37 weeks or higher

Introduction. Management and the prevalence of labor complications in patients with premature rupture of the membranes (PROM) is a pressing issue.
Aim: to assess the features of childbirth course in patients with PROM during a full-term pregnancy and a favourable cervix.
Materials and methods. А prospective analysis of labor course and the postpartum period was performed in 189 patients with a singleton pregnancy with occipital presentation, at least 37-week gestation, of low and moderate risk groups, without contraindications for vaginal delivery. PROM as complicated pregnancy was found in 89 subjects (main group), whereas 100 having labor onset with intact fetal membranes were enrolled into comparison group. The features of labor course were analyzed.
Results. Primiparous patients dominated in the main group (66.7 %). The latent period between amniotic fluid discharge to labor onset comprised 4.15 ± 3.48 hours and 3.40 ± 2.13 hours in primiparous and multiparous women, respectively, whereas labor activity in 19 % of women did not develop after 6 hour-latent period. The average duration of labor did not depend on the patient parity and was longer in the group with PROM: 8.06 ± 3.51 hours – in primiparous females, 7.21 ± 2.56 hours – in comparison group (T = –1.99; p = 0.04) due to prolonged first stage of labor. In patients with and without PROM, rate of poor uterine contraction strength was 24.7 % and 18.3 % (p = 0.29), cervical dystocia – 2.25 % and 0 % (p = 0.13), use of oxytocin in childbirth – 35.9 % and 18.3 % (p = 0.007), respectively. Caesarean sections in the main group were recorded in 15 cases (16.85 %), fetal vacuum extraction – 6 cases (6.74 %), whereas in the comparison group – per 2 (2,0 %) cases, respectively (χ2 = 16.13; p < 0.001).
Conclusion. Patients with PROM and favourable cervix were shown to have duration of labor, occurrence of operative delivery, rupture of the cervix, and use of oxytocin lasting substantially longer compared to those with the rupture of membranes after onset of the labor. PROM with a favourable cervix occurs more often in primiparous females, which is also coupled to peak rate complications. A 6-hour expectant management is considered as insufficient, because an onset of labor activity in 15.7 % of patients developed after latent period lasting more than 6 hours.

1. Tan B.P., Hannah M.E. Oxytocin for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev. 2000;(2):CD000157. https://doi.org/10.1002/14651858.CD000157.

2. Caughey A.B., Stotland N.E., Washington A.E., Escobar G.J. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol. 2007;196(2):155.e1–6. https://doi.org/10.1016/j.ajog.2006.08.040.

3. Chacón K.M., Bryant Mantha A.S., Clapp M.A. Outpatient expectant management of term prelabor rupture of membranes: a retrospective cohort study. Am J Perinatol. 2019. DOI: 10.1055/s-0039-3400997.[Online ahead of print].

4. Afanasyeva M.Kh., Bolotskikh V.M., Polyakova V.O. Premature rupture of membranes (modern view to etiology and pathogenesis, prediction perspectives). [Prezhdevremennoe izlitie okoloplodnyh vod (sovremennye vzglyady na etiologiyu i patogenez, perspektivy prognozirovaniya)]. Zhurnal akusherstva i zhenskih boleznej. 2014;63(3):4–11. (In Russ.).

5. Bolotskikh V.M. Current ideas about the etiology and pathogenesis of premature amniotic fluid outflow. [Sovremennye predstavleniya ob etiologii i patogeneze prezhdevremennogo izlitiya okoloplodnyh vod]. Zhurnal akusherstva i zhenskih boleznej. 2011;60(2):3–13. (In Russ.).

6. Bolotskikh V.M. Premature rupture of membranes: etiology, pathogenesis, diagnosis, tactics of pregnancy and childbirth, prevention: study guide. Ed. E.K. Aylamazyan. [Prezhdevremennoe izlitie okoloplodnyh vod: etiologiya, patogenez, diagnostika, taktika vedeniya beremennosti i rodov, profilaktika: uchebno-metodicheskoe posobie. Pod red. E.K. Ajlamazyana]. SPb.: Izd-vo N.–L., 2014. 32 s. (In Russ.).

7. Kuba K., Bernstein P.S. ACOG practice bulletin No. 188: prelabor rupture of membranes. Obstet Gynecol. 2018;131(6):1163–4. https://doi.org/10.1097/AOG.0000000000002663.

8. Fankhauser C., Bürklin I., Hodel M., Origlia Ikhilor P. Vorzeitiger spontaner Blasensprung am Termin: Hospitalisation oder ambulantes Management? Eine Erhebung in Deutschschweizer Geburtsinstitutionen. Z Geburtshilfe Neonatol. 2016;220(05):207–14. https://doi.org/10.1055/s-0042-111016.

9. Order of the Ministry of Health of the Russian Federation of November 1, 2012 No. 572n «On approval of the Procedure for the provision of medical care in the field of Obstetrics and Gynecology (except for the use of assisted reproductive technologies)». Registered in the Ministry of Justice of the Russian Federation on April 2, 2013 Registration N 27960. [Prikaz Ministerstva zdravoohraneniya RF ot 1 noyabrya 2012 g. № 572n Ob utverzhdenii Poryadka okazaniya medicinskoj pomoshchi po profilyu «Akusherstvo i ginekologiya (za isklyucheniem ispol'zovaniya vspomogatel'nyh reproduktivnyh tekhnologij)». Zaregistrirovano v Minyuste RF 2 aprelya 2013 g. Registracionnyj N 27960.]. Moskva, 2012. 218 p. (In Russ.). Available at: https://rd1.medgis.ru/uploads/userfiles/organization_137/docs/prikaz-mz-572-01.11.12-akush.pdf. [Accessed: 10.05.2020].

10. World Medical Association Declaration of Helsinki: Recommendations for Physicians for Biomedical Research in Humans. Available at: https://www.mediasphera.ru/journals/mjmp/2000/4/r4-00-20.htm. [Accessed: 10.05.2020].

11. Baev O.R., Vasilchenko O.N., Kan N.E. et al. Clinical guidelines for preterm amniorrhea. [Prezhdevremennyj razryv plodnyh obolochek (prezhdevremennoe izlitie vod)]. Akusherstvo i ginekologiya. 2013;(9):123–34. (In Russ.).

12. Page K., McCool W.F., Guidera M. Examination of the pharmacology of oxytocin and clinical guidelines for use in labor. J Midwifery Womens Health. 2017;62(4):425–33. https://doi.org/10.1111/jmwh.12610.

13. Edwards R.K., Szychowski J.M., Berger J.L. et al. Foley catheter compared with the controlled-release dinoprostone insert: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1280–7. https://doi.org/10.1097/AOG.0000000000000238.

14. Premature rupture of membranes. Current approaches to diagnosis and treatment. Eds. V.E. Radzinsky, I.M. Ordian. Information mail. [Prezhdevremennyj razryv plodnyh obolochek. Sovremennye podhody k diagnostike i lecheniyu. Pod red. V.E. Radzinskogo, I.M. Ordiyanc. Informacionnoe pis'mo]. Moskva: Mediabyuro StatusPraesens, 2011. 20 s. (In Russ.). Available at: http://orenroddom.ru/userfiles/ufiles/prezhdevremennyy_razryv_plodnykh_obolochek.pdf. [Accessed: 10.05.2020].

15. Thomson A.J. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation: Greentop Guideline No. 73. BJOG. 2019;126:e152–166. https://doi.org/10.1111/1471-0528.15803.

16. Oxytocin augmentation and induction of labour infusion. South Australian Perinatal Practice Guidelines, 2014. 8 p. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/c21671004ee53776a6beafd150ce4f37/oxytocin+augmentation++IOL_Feb2015.pdf?MOD=AJPERES. [Accessed: 10.05.2020].

17. Term prelabour rupture of membranes (Term PROM). Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2017. 13 p. Available at: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Term-Prelabour-Rupture-of-Membranes-(Term-Prom)-(C-Obs-36)-review-2017.pdf?ext=.pdf. [Accessed: 10.05.2020].

18. Providing medical care for singleton births in the occipital presentation (without complications) and in the postpartum period. Clinical recommendations. [Okazanie medicinskoj pomoshchi pri odnoplodnyh rodah v zatylochnom predlezhanii (bez oslozhnenij) i v poslerodovom periode]. Klinicheskie rekomendacii. 2014. 27 s. (In Russ.). Available at: https://prof.ncagp.ru/upload/files/conf/rody_zad_2014.pdf. [Accessed: 11.05.2020].

19. Smith M. Management of PROM at term. J Fam Pract. 1997;45(3):198–9.

20. Parry S., Strauss J.F. Premature rupture of the fetal membranes. N Engl J Med. 1998;338(10):663–70. https://doi.org/10.1056/NEJM199803053381006.

21. Zemlyanaya V.P. The course and outcome of labour complicated by premature rupture of water, depending on the method of their introduction. [Techenie i iskhod rodov, oslozhnennyh prezhdevremennym izlitiem vod, v zavisimosti ot metoda ih vedeniya]. Avtoref. dis. kand. med. nauk. Moskva, 1973. 21 s. (In Russ.).

22. Lyzikov N.F. Materials for the study of the causes and pathogenesis of premature rupture of amniotic fluid and differentiation of pregnancy and childbirth in this complication. [Materialy k izucheniyu prichin i patogeneza prezhdevremennogo othozhdeniya okoloplodnyh vod i differencirovanie vedeniya beremennosti i rodov pri etom oslozhnenii]. Avtoref. dis. dokt. med. nauk. Minsk, 1968. 43 s. (In Russ.).

23. Wing D.A., Guberman C., Fassett M. A randomized comparison of oral mifepristone to intravenous oxytocin for labor induction in women with prelabor rupture of membranes beyond 36 weeks’ gestation. Am J Obstet Gynecol. 2005;192(2): 445–51. https://doi.org/10.1016/j.ajog.2004.07.058.

24. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007;109(4):1007–19. https://doi.org/10.1097/01.AOG.0000263888.69178.1f.

25. Savitsky A.G. Hypertensive uterine dysfunction in the first stage of labor. [Gipertonicheskaya disfunkciya matki v pervom periode rodov]. Avtoref. dis. dokt. med. nauk. SPb., 2008. 40 s. (In Russ.).

26. Hjertberg R., Hammarstrom M., Moberger B. et al. Premature rupture of the membranes (PROM) at term in nulliparous women with a ripe cervix. A randomized trial of 12 or 24 hours of expectant management. Acta Obstet Gynecol Scand. 1996;75(1):48–53. https://doi.org/10.3109/00016349609033283.

27. Mozurkewich E.L., Chilimigras J.L., Berman D.R. et al. Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth. 2011;27(11):84. https://doi.org/10.1186/1471-2393-11-84.

28. Pintucci A., Meregalli V., Colombo P., Fiorilli A. Premature rupture of membranes at term in low risk women: how long should we wait in the «latent phase»? J Perinat Med. 2014;42(2):189–96. https://doi.org/10.1515/jpm-2013-0017.

29. Bolotskikh V.M., Milyutina Yu.P. Premature rupture of amniotic fluid: immunological and biochemical aspects of the problem, diagnostic questions and management tactics. [Prezhdevremennoe izlitie okoloplodnyh vod: immunologicheskie i biohimicheskie aspekty problemy, voprosy diagnostiki i taktiki vedeniya]. Zhurnal akusherstva i zhenskih boleznej. 2011;60(4):104–16. (In Russ.).

30. Sperling L.S., Schantz A.L., Wahlin A. et al. Management of prelabor rupture of membranes at term. A randomized study. Acta Obstet Gynecol Scand. 1993;72(8):627–32. https://doi.org/10.3109/00016349309021155.

31. Radzinsky V.E. Obstetric aggression v. 2.0. [Akusherskaya agressiya v. 2.0]. Moskva: StatusPraesens, 2017. 872 s. (In Russ.).

32. WHO recommendations. Intrapartum care for a positive childbirth experience. WHO, 2018. 210 p. Available at: https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf. [Accessed: 10.05.2020].

33. Grigoryeva Yu.V., Suvorova G.N., Tulaeva O.N. et al. Characterization of the main cellular differential tissue of the definitive cervix uteri. [Harakteristika osnovnyh kletochnyh differonov tkanej definitivnoj shejki matki]. Aspirantskij vestnik Povolzh'ya. 2018;(1–2):12–6. (In Russ.). https://doi.org/10.17816/2075-2354.2018.18.12-16.

34. Astafiev V.V., Nazarova S.V., Lee A.D., Podzolkova N.M. The current state of the problem of premature outflow of amniotic fluid in full-term pregnancy (literature review). [Sovremennoe sostoyanie problemy prezhdevremennogo izlitiya okoloplodnyh vod pri donoshennoj beremennosti (obzor literatury)]. Arhiv akusherstva i ginekologii imeni V.F. Snegiryova. 2017;4(4):187–93. (In Russ.). https://doi.org/10.18821/2313-8726-2017-4-4-187-193.

35. Dmitrienko K.V., Igitova M.B. The clinical-diagnostic significance of inflammatory response in women with premature rupture of membranes in full-term pregnancy. [Kliniko-diagnosticheskoe znachenie pokazatelej vospalitel'nogo otveta u zhenshchin s prezhdevremennym izlitiem okoloplodnyh vod pri donoshennoj beremennosti]. Voprosy ginekologii, akusherstva i perinatologii. 2014;13(5):27–32. (In Russ.).

36. Knyazeva T.P. Causes and risk factors of premature rupture membranes. [Prichiny i faktory riska prezhdevremennogo razryva plodnyh obolochek]. Dal'nevostochnyj medicinskij zhurnal. 2016;(2):128–35. (In Russ.).