Management of pre-labour rupture of membranes at term - A survey of current practice in Australia

Abstract

Women with pre-labour rupture of membranes at term (Term-PROM) commonly choose to have early induction of labour with the use of oxytocin. Although there is evidence of efficacy and safety of induction by the use of prostaglandin, it is used infrequently in Australia. To identify current practice and views of obstetricians in Australia, on Term-PROM. A postal survey among all obstetricians in Australia in April 2009. Fellows no longer practising obstetrics or who were non-practising were asked to return the survey without completing it. Of the 1319 surveys posted, 720 (54.6%) were returned, 23.8% of whom were practising only gynaecology or non-practising, leaving 548 respondents practising obstetrics (41.5%). The most common management of Term-PROM is induction of labour (IOL) within 24 h at the next convenient opportunity (75%). More than 96% would use intravenous oxytocin at some stage as their method of induction. Prostaglandin gel (PGE₂) was utilised by 15% of respondents regularly, mainly for ripening of an unfavourable cervix in a primigravida, but nearly 40% would consider the use of PGE₂ indicating that it would produce a more 'natural' labour, that women could ambulate more and that there would be reduced impact on midwifery staff. For those who would not consider PGE₂, the most common reasons were concerns of hyperstimulation, increased infection rate and precautions of use based on product information. Oxytocin is the most widely used induction agent for women with term-PROM. PGE₂ is an important alternative method of induction and nearly 40% would consider using it. Clarification from RANZCOG and further studies on whether PGE₂ offers a safe and effective option are now required.