Early Induction Of Labor Research Articles

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

Nursing Care of Labor Induction in 2 Cases of Upper GI Bleeding in Pregnancy Complicated with Decompensated Cirrhosis

Objective: To summarize the nursing experience of induced labor of upper gastrointestinal bleeding in pregnancy complicated with decompensated cirrhosis. Methods: To treat two pregnant women with upper gastrointestinal bleeding complicated with decompensated cirrhosis with early labor induction, strengthen the nursing of upper gastrointestinal bleeding before operation, monitor changes of the patient’s condition closely after operation, and strengthen the prevention and treatment of postpartum complications and health guidance. Results: No serious complications occurred in the 2 patients after operation. They were hospitalized for 11 and 17 days after operation and were discharged stably. Conclusion: The pregnant women with upper gastrointestinal bleeding complicated with decompensated cirrhosis should terminate pregnancy in time and strengthen perinatal nursing, which can improve the liver function and blood coagulation and improve the prognosis of the patients.

Prenatal assessment of fetal lung to liver signal intensity ratio using magnetic resonance imaging to predict neonatal respiratory outcome

Introduction: Fetal and maternal health problems lead to increase in incidence of preterm birth that has become a major concern in obstetric practice. Perinatal survival depends crucially on a sufficiently sized and a functionally developed cardiopulmonary system. So it is extremely important to diagnose lung maturity before birth because of the increase in the indications for early induction of labour. In these conditions, assessing the lung maturity will decide timing for inducing labour. Fetal MRI is a recently developing field that provides adequate information regarding the size, structure and biochemical maturity of developing Fetal lung that overcomes the adverse effects of amniocentesis. Therefore a ratio is considered for comparing the signal intensity of the Fetal lungs with that of another structure at a comparable depth. The ideal criteria for the reference structures are sufficient size, close proximity to the lung, homogeneity and stability through the pregnancy.Aim: Our aim was to establish a linear relationship between the estimated gestational age and the Lung- Liver Signal Intensity Ratio (LLSIR) values and to ultimately predict the lung maturity from this relationship.Materials and Methods: The patients for this study were selected from the antenatal outpatient department of a large medical college hospital in Chennai, India. The study population consisted of a total of 50 patients who were referred from the antenatal OPD for MRI for various other indications. The liver and lung images were taken in the same imaging plane for the analysis either in the coronal or sagittal view.Results: Magnetic resonance imaging of 50 cases were carried out during 19th and 40th week of gestationin antenatal women with age group from 23 to 31 years. LLSIR was calculated by taking the ratio of lung and liver signal intensity. The range of LLSIR is 1.54 to 4.03(2.808+0.739, mean+SD). There was no significant correlation between the liver intensity and EGA. The range of liver intensity was from 175 to 707 (425.08+115.22, mean+SD). The Pearson correlation coefficient between liver intensity and EGA was 0.232(p

751: The risk of stillbirth at term and timing of delivery in obese women

The proportion of obesity in women of reproductive age has been increasing throughout the years. Previous studies have shown that a high body mass index (BMI) is an independent risk factor for stillbirth. The purpose of this study was to determine if obese women should receive early induction of labour to decrease the risk of stillbirth in this population. We conducted a retrospective population-based cohort study using the United States’ Center for Disease Control and Prevention’s Period Linked Birth-Infant Death and Fetal Death data. The study population included all singleton, term or post-term births with a recorded pre-pregnancy BMI that occurred between 2014 and 2017, inclusively. The rate of stillbirths in each BMI class was calculated at each gestational week from 37 weeks and onwards. Of the total of 12,750,751 births in our cohort that met study criteria, 46.77% were to women with a normal weight (BMI=18.5-24.9 kg/m2), 26.94% were to women who were classified as overweight (BMI = 25-29.9 kg/m2), 14.52% were to women in obesity class I (BMI = 30.0-34.9 kg/m2), 6.96% in obesity class II (BMI = 35.0-39.9 kg/m2) and 4.82% in obesity class III (BMI ≥40.0 kg/m2). There were 15,162 cases of term stillbirths over the period of 4 years, for an overall rate of 11.89/10,000 births. Rates of stillbirth appeared to be relatively constant over the study period. As compared to women with a normal BMI, there was a higher rate of stillbirth at each gestational age from 37 weeks among women who were overweight and obese with a dose dependant relationship with respect to BMI. In particular, among morbidly obese women with a BMI of ≥40.0 kg/m2, there was a significant increase in the rate of stillbirth between 39 and 40 weeks. As of 37 weeks of gestation, the rates of stillbirths among women with a high BMI, particularly above 40kg/m2, is considerably greater than for women with a normal BMI. Consideration should be given to early induction among these women as of 37 weeks to reduce the increased risk of stillbirth.

A prospective cohort study of perinatal outcomes: pregnancies with isolated oligohydramnios versus normal pregnancies

Background: Pregnancies with oligohydramnios at term in the absence of fetal and maternal compromise pose a dilemma in management. Evidence regarding the outcome of these pregnancies are controversial, and it is one of the common reason for early induction of labour in the fear of adverse perinatal outcome. Outcomes of such pregnancies are not adequately studied in Sri Lankan setting. Objective: To compare the perinatal fetal outcomes of isolated oligohydramnios with normal pregnancy at term among women who were admitted to Teaching Hospital Kandy. Methods: A prospective cohort study was carried out. All the pregnant mothers admitted to ward 7 Teaching Hospital Kandy at term were routinely scanned for fetal growth and amniotic fluid volume. Women with isolated oligohydramnios (n=70) and without any other pregnancy-related complications were selected as controls. Two controls (normal pregnancy n=140) were selected per case matching the age and parity. These pregnant mothers were followed up from the date of admission to discharge. Immediate perinatal fetal and postnatal outcomes were assessed. Data were entered and analyzed by SPSS 22.0. Results: The majority of the patients (58.5%) with isolated oligohydramnios were induced early, and a significant number of these patients have undergone emergency caesarian section (X2=12.98, p=0.003). Although pregnancies with isolated oligohydramnios tends to have more CTG abnormalities, it was not statistically significant (X2=4.29, p=0.12). But, the incidence of significant meconium-stained liquor was higher than normal pregnancies (X2=6.02, p=0.049). However, the fetal outcome APGAR Conclusion and recommendation: Compared to normal pregnancies, pregnancies with isolated oligohydramnios didn't show any statistically significant difference in perinatal outcome. Oligohydramnios itself doesn’t indicate the fetal compromise when other growth parameters were normal. However, as there are controversies in management further researches are needed in this field.

Obstetric outcomes following atrial and arterial switch procedures for transposition of the great arteries (TGA) - A single, tertiary referral centre experience over 20 years.

Repair of transposition of the great arteries usually involves an atrial switch or arterial switch operation, which can complicate physiological adaptation to the demands of pregnancy and adversely affect the fetus. We retrospectively compared outcomes of 48 completed pregnancies in 23 women with surgically corrected transposition of the great arteries (38 atrial switch/10 arterial switch operation) under joint cardiac-obstetric care in our tertiary referral clinic between 1997 and 2017. Most women delivered vaginally (85%). The pre-term delivery rate was high (atrial switch 39%; arterial switch operation 40%). Small for gestational age occurred in 56% of babies, significantly more in the atrial switch group (66%) than arterial switch operation (20%), p = 0.013. Women with surgically corrected transposition of the great arteries wishing to become pregnant are at high risk of obstetric complications, primarily pre-term delivery and small for gestational age baby. They require more careful ultrasound surveillance beyond 36 weeks' gestation and/or may benefit from early induction of labour. Trial registration: Text/Not applicable.

A preliminary investigation of the effects of labour inducing plant, Cissampelos mucronata, on the outcomes of pregnancy using rat models.

The use of traditional remedies in pregnancy has been associated with bad obstetric outcomes including uterine rupture and foetal distress. These outcomes may ultimately lead to maternal and child mortality or morbidity. Few studies have been done to measure the effects of various herbs in pregnant women or a developing fetus. This study investigated the effects of the commonly used labour inducing plant, Cissampelos mucronata, on pregnancy outcomes using a rat model. Pregnant female rats were divided into 3 groups of 10 each. The first group was the control. The second group was treated with the aqueous extract of Cissampelos mucronata at mid-pregnancy. The third group was treated with Cissampelos mucronata close to full term. All the groups were left to give birth and outcomes were recorded. Rats treated at mid-term had significantly low number of pups when compared to the control group as well as the close to term treated group (4.1 ± 0.54 vs. 6.4 ± 0.60; 6.2± 0.56). The mid-term treated rats had pups with significantly lower body weight when compared to the control and the close to term treated groups (3.73 ± 0.36g vs. 5.37 ± 0.16g; 4.27 ± 0.1g). The average gestation period was significantly short in the mid-term treated group when compared to the control and the close to term treated groups (18.16 ± 0.50 days vs. 20.40 ± 0.44 days; 20.12 ± 0.37 days). There were no uterus ruptures observed in all study groups 3 days after delivery. Administration of Cissampelos mucronata during pregnancy leads to early induction of labour.

Induction of labour in term premature rupture of membranes; oxytocin versus sublingual misoprostol; a randomised clinical trial

Premature rupture of the membranes (PROM) occurs in about 8–10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM cases with term pregnancy. A total of 270 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The first group underwent Oxytocin infusion according to low-dose standard protocol and the second group received 25 μg sublingual Misoprostol every 4 h. Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in misoprostol group (p < .05). Although, some maternal side-effects were significantly higher in misoprostol group (p < .001), but 5 minute Apgar score was significantly better in this group. In conclusion, sublingual misoprostol was associated with better neonatal outcomes was more effective than oxytocin for labour induction in PROM cases. Impact statement What is already known on this subject: PROM occurs in about 8–10% of pregnancies; about 60% of these cases are term pregnancies. Most experts recommend early induction of labour in term PROM cases with an eye towards avoiding increased morbidity and mortality. Oxytocin is the most frequently used agent that is administered intravenously for the purpose of labour induction. Misoprostol is an alternative to oxytocin and is simpler to use, as it is administered via the oral, buccal, sublingual, rectal and vaginal routes rather than intravenously. What do the results of this study add: Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in the misoprostol group. Although, some maternal side-effects were significantly higher in misoprostol group, the 5 minute Apgar score was significantly better in this group. What are the implications of these finding for clinical practice and/or further research: Sublingual misoprostol for induction of labour in PROM cases is more effective than oxytocin and its neonatal outcomes are better. Due to its easy prescription and better labour outcomes, sub lingual misoprostol may be a better choice for labour induction in PROM cases.

Childbearing Choices: What Helps, What Doesn't, and What You Thought You Knew

AbstractChildbearing is an increasingly complicated matter, which has evolved significantly over the past several decades. Treatment options for infertility have expanded. Prenatal testing and treatment have led to an evolution in obstetrical decision‐making, wherein the risks and benefits to the fetus and future child are better understood and more strongly considered in medical management of the pregnant woman. Obstetrics appears to be increasingly interventional; one in three babies in the United States is now born by cesarean section. Neonatal intensive care has markedly improved outcomes for premature babies. A pregnant woman may now be presented with many options— obstetrician or midwife, home or hospital delivery, choices among prenatal testing and monitoring, early induction of labor, cesarean delivery. Health care professionals face similar decisions with regard to what they recommend and the boundaries of safe and responsible care they should make available. Preterm Babies, Fetal Patients, and Childbearing Choices, by John D. Lantos and Diane S. Lauderdale, provides an excellent overview of the available information relevant to these questions.

Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?

Induction of labor among pregnant women with high levels of total bile acid (TBA) is common among clinicians. We examined, if women with intrahepatic cholestasis of pregnancy (ICP) and TBA≥40μmol/l have a higher risk of maternal-fetal complications, when labor is induced at 37weeks of gestation, compared with induction of labor at term in women with low-risk ICP. Retrospective cohort study of 16,185 women delivering at Roskilde University Hospital in the period 2006-2011. Women with high-risk ICP (TBA≥40μmol/l) had labor induced at 37weeks of gestation; women with low-risk ICP (TBA<40μmol/l) at term. Mode of delivery, duration of induction procedures, highest level of TBA and alanine aminotransferase (ALT) and for the neonates: Apgar scores at 5min, umbilical cord pHs and SBEs, NICU admissions and birthweights. The incidences of ICP was 1.2% (95% CI 1.05-1.39%) altogether and for high-risk ICP 0.4% (95% CI 0.27-0.46%). No difference was found in mode of delivery, length of induction of labor nor in neonatal outcomes, except for an expected difference in birthweight. In high-risk ICP, ALT was not raised in 10.3% (95% CI 2.5-18.2%). Early induction of labor at 37weeks of gestation seems justified in high-risk ICP, as, except for abbreviating gestational age by 9days with 296g smaller babies, induction of labor was not followed by detectable maternal-fetal disadvantages and is favored by an expected major reduction in ICP stillbirth risk.

Early induction of labour versus delayed induction following prelabour rupture of fetal membranes at term

Objective The aim of this study was to compare both maternal and fetal outcome in patients with confirmed prelabour rupture of membranes (PROM) at term after early induction of labour shortly after the rupture of membranes (within 6 h) versus delayed induction 24 h after expectant management of PROM. Design The study was conducted as a randomized controlled trial. Tertiary referral centre participants included women with premature rupture of membranes randomly divided into two groups. Group 1 comprised 50 patients in whom labour was induced within 6 h after rupture of the membranes and group 2 comprised 50 patients who did not go into spontaneous labour 24 h after expectant management of PROM when labour was then induced. Results The rate of cesaerean section was significantly different among the study groups (12% in G1 vs. 28% in G2). There was no significant difference between the two groups as regards Apgar scores after 1 and 5 min. There was no incidence of maternal or neonatal mortalities in both groups. Conclusion Immediate induction of labour for women with term PROM has relatively better maternal and neonatal outcome compared with delayed induction after 24 h of conservative management.

PFM.41 Obstetric cholestasis: What is the future for its diagnosis and management

AimObstetric cholestasis (OC) is an incompletely understood hepatobiliary disease that typically affects women in the third trimester of pregnancy. It is associated with increased morbidity and mortality for the fetus,...

Induction of Labor for Term Small-for-Gestational-Age Fetuses

Induction of labor (IOL) when the fetus appears small for gestational age (SGA) toward term may improve perinatal outcomes and prevent fetal death. If these fetuses are small as a variant of the normal spectrum, early induction may not improve outcomes and may cause obstetric complications. This study was undertaken to determine the impact of early IOL on neonatal outcomes and rates of maternal obstetric interventions in SGA term infants. The cohort included all term singleton deliveries and their neonatal outcomes occurring in 2004 to 2008. Maternal and neonatal outcomes of term (37–42 weeks) growth-restricted singleton deliveries were analyzed. Small for gestational age was defined as birth weight lower than the 10th percentile adjusted for gestational age and sex. The exposed group, termed early-induction SGA group, included women giving birth after IOL for suspected intrauterine growth restriction (IUGR) of a singleton SGA neonate at 37 to 39 weeks. The unexposed group, or no-early-induction SGA group, included women giving birth at 40 weeks of gestation or later and those who gave birth spontaneously to term SGA neonates at 37 to 39 weeks. Maternal characteristics, pregnancy and neonatal complications, and obstetric interventions were compared to evaluate benefits/drawbacks of early term IOL for IUGR. Of 37,342 women who had a singleton neonate at 37 weeks of gestation or later, 2378 (6.36%) neonates were born SGA. The early-induction and no-early-induction SGA groups included 445 and 1933 neonates, respectively. Most obstetric complications were similar in the 2 groups. Women in the early-induction group had significantly more hypertensive complications and a higher rate of cesarean deliveries compared with the unexposed group, and only 65.5% reached noninstrumental vaginal delivery (P < 0.0001). Neonatal Apgar scores at 1 and 5 minutes and sex were similar between the 2 groups. Compared with the unexposed group, the early-induction group had higher rates of hyperbilirubinemia necessitating phototherapy (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.21–2.53) and hypoglycemia (OR, 2.38; 95% CI, 1.56–3.62). Two neonates in the early-induction group had respiratory complications. Necrotizing enterocolitis, sepsis, adverse neurologic outcomes, and need for resuscitation were rare and similar in both groups. No neonates died. The risk for any adverse neonatal outcome was ~2 times higher for the early-induction compared with the unexposed group (OR, 1.95; 95% CI, 1.46–2.61; P < 0.0001). The most significant danger in abstaining from IOL for IUGR at term is intrauterine fetal death. Of 37,342 singleton deliveries, 33 fetal deaths occurred at 37 to 42 weeks, 0.88 cases per 1000 live births at term; only 1 was an SGA fetus at 37 weeks. The risk for intrauterine fetal demise at term for non–early-induction SGA was 0.52 cases per 1000 live births, similar to that of the general term population (OR, 0.57; 95% CI, 0.08–3.85; P = 0.99). For suspected IUGR at term, awaiting spontaneous labor risks fetal decompensation, yet active IOL might increase rates of obstetric interventions and neonatal complications of early term delivery. This study found no apparent neonatal benefit for early term IOL for SGA neonates.

2260 AN INSTITUTIONAL REVIEW OF ANESTHETIC TIMES FOR URINARY STONES IN PREGNANT WOMEN

INTRODUCTION AND OBJECTIVES: Management options for urolithiasis during pregnancy include trial of passage, temporizing ureteral stent or nephrostomy tube, and definitive treatment with ureteroscopy. Prior research suggests children can suffer adverse long term effects from exposure to medications used for general anesthesia. Specifically, anesthesia exposure greater than two hours or greater than two separate anesthesia exposures prior to the age of four years has been associated with the development of learning disabilities. The goal of this study is to compare the potential anesthesia risk to the fetus when temporizing stents are placed compared to definitive management with ureteroscopy. METHODS: We retrospectively reviewed the records of patients diagnosed with urolithiasis during pregnancy who underwent surgical intervention from 1997 to 2012. Patients were evaluated for a confirmed stone event, defined as a stone visualized on imaging or at surgery, along with management strategy including duration and frequency of anesthetic events. RESULTS: We identified 26 women with urolithiasis during pregnancy who met our inclusion criteria, of which 15 (58%) were managed with stents and 11 (42%) underwent ureteroscopic intervention. In the stent group 6 (40%) required multiple stent exchanges for a mean of 1.47 (range 1-3) anesthetic events and median anesthetic time of 70 minutes (range 29-208 min). Seven (47%) of the women managed with ureteral stent exchange were induced prior to term due to inability to tolerate the stent. Overall the ureteroscopy group had a mean of 1.18 anesthetic events (range 1-2) and 80 minutes (range 37-126 min) of anesthetic exposure. Two (18%) required two procedures either for infection or narrow ureter. None were induced early for pain. Comparing the two groups, there was no significant difference in number of events (p 0.208) or total anesthetic time (p 0.503). CONCLUSIONS: Ureteroscopic intervention appears safe and effective in treating acute stone events with equivalent if not less anesthetic exposure to the fetus compared to temporizing ureteral stents. Furthermore, early induction of labor due to pain is not a concern with ureteroscopy, as it has been shown to be with ureteral stenting. Our study provides further support to the role of definitive stone management instead of temporizing measures during pregnancy.

A Contemporary Approach to the Obstetric Management of Women with Heart Disease

ObjectivesRecommendations for the peripartum obstetric management of women with heart disease have included early induction of labour, shortening the second stage of labour during vaginal delivery, and low threshold for elective Caesarean section, although such techniques may result in complications. The objective of this study was to determine whether a less aggressive approach without routine preterm induction, shortening of the second stage,or Caesarean section adversely affects the mother or neonate. MethodsWe examined peripartum obstetric management and its relationship with adverse maternal and neonatal outcomes in 1677 pregnancies: 559 in women with heart disease and 1118 in women without heart disease (control subjects). Logistic regression with propensity matching was used to compare outcomes in women with and without heart disease. ResultsWomen with heart disease were more likely than control subjects to undergo induction of labour (P < 0.001). Induction of labour tended to be at term and for logistical reasons, not for the indication of maternal heart disease. Assisted vaginal deliveries were more common in women with heart disease (29% vs. 11%, P < 0.001) than in those without, and the second stage of labour was also more prolonged in women with heart disease. Rates of Caesarean section were similar in both groups (P = 0.66). A significant proportion of women with heart disease had unassisted vaginal deliveries. Invasive cardiac monitoring was rarely used. Adverse maternal cardiac events at delivery were rare (2% of pregnancies) and were not associated with mode of delivery. In multivariate analysis, maternal heart disease was not predictive of adverse neonatal events or third- or fourthdegree lacerations. Maternal heart disease was associated with postpartum hemorrhage, but this was not related to assisted delivery or prolonged second stage of labour. ConclusionThis large study has shown that in women with heart disease, avoidance of early induction of labour, rare use of Caesarean section for cardiac indications, and selective use of invasive monitoring produces safe obstetric outcomes.

Intra-abdominal Umbilical Vein Varix Thrombus

Fetal intra-abdominal umbilical vein varix (FIUVV) is an uncommon finding with poorly understood clinical significance. Numerous fetal complications are associated with this anomaly. This case report demonstrates FIUVV in which thrombus develops leading to early induction of labor for successful delivery. The literature regarding FIUVV is reviewed and discussed with implications for sonographic follow-up during pregnancy and patient management.

Premature Rupture of Membrane at Term: Early Induction Versus Expectant Management

Premature rupture of membrane is managed either expectantly or actively. The purpose of the study was to assess the effectiveness of early labor induction with cervical prostaglandin E2 versus expectant management in women with term premature rupture of membrane. Singleton pregnancy cases with cephalic presentation reported between 37 and 41weeks of pregnancy with PROM of <6h and cervical dilatation <3cm were studied over a period of 2years. Out of 100 patients studied, half of them were managed by expectant protocol and the other half by early induction within 6h of PROM with intracervical gel. Main outcomes measured were PROM-delivery interval, mode of delivery, neonatal and maternal morbidity, and period of maternal and/or neonatal hospitalization. Chi-square test was used to compare frequencies between two groups. Differences between means of other measurement were compared by independent t test. PROM-delivery interval was 22h in expectant group, while in early induction group, it was 13h (p value<0.001). Rate of cesarean section remained almost same in both groups. Increases in maternal-neonatal infection rate and hospital stay were noted in expectant group; however, this was not statistically significant. Immediate labor induction with prostaglandin in cases of term PROM shortens delivery interval and maternal hospital stay with reduction in maternal-neonatal sepsis.

Failed Induction of Labor: Strategies to Improve the Success Rates

The rates of induction of labor (IOL) are rising all over the world. In developed countries, one of every 4 babies is born after IOL at term. The recent World Health Organization guidelines on IOL recommend that failure of induction does not necessitate cesarean delivery [WHO recommendations for induction of labor. World Health Organization, 2011]. These guidelines come when there are concerns that failed primary inductions in nulliparous women, which have led to escalation of the cesarean delivery rates. Obstetricians must recognize the risks associated with IOL (including failure and need for cesarean delivery) and avoid inductions for borderline indications, which are not evidence based. The issue of "failed induction of labor" is topical, and there is a need to define this entity and offer alternatives to cesarean delivery in the management of this group of women. Research is required to develop a test to accurately identify those fetuses most at risk of morbidity or stillbirth who would truly benefit from an early IOL and assess the cost-effectiveness of policies of routine IOL. In this review, we summarized the current recommendations for best practice in the area of IOL, defined "failed induction," and described options to improve the success rate after "failed primary induction of labor." Obstetricians & Gynecologists and Family Physicians. After the completing the CME activity, physicians should be better able to classify the factors determining success or failure of induction of labor, counsel women about risks and benefits of various methods of induction of labor, and compare the options of management available after failed primary induction of labor.

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

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.