I have a student (I am a CBE) who met with a doctor who said if her water broke before the onset of labor and if she had no contractions after an HOUR, he would induce.

Can you please direct me toward some literature that I can share with her that goes against that doctor's suggestion? I thought 12 hours was a very conservative wait, so one hour seems absurd to me. This doctor is a maternal-fetal specialist.

Here is what the recent Cochrane systematic review had to say on the subject along with my comments. I'm excerpting from slides presented at Lamaze International's 2007 annual conference. Amy Romano and I teamed up to do the annual research update.

-- Henci

Dare, M. R., Middleton, P., Crowther, C. A., Flenady, V. J., & Varatharaju, B. (2006). Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev(1), CD005302.

•         Review: Systematic review of 12 trials of planned induction vs. expectant management totaling 6800 women (Hannah [1996] contributed 74% of them)

•         Results: Induction compared with expectant management

–        no difference in neonatal infections (9 trials, N = 6400)

–        relative risk of admission to NICU: 0.72 (5 trials, N = 5700) BUT

•         reviewers state may be differences in hospital policy

–        relative risk of chorioamnionitis: 0.74 (9 trials, N = 6600) BUT

•         chorioamnionitis defined as fever before or during labor

•         absolute difference [calculated from data] 3.1%

•         chorioamnionitis may be associated with number of vaginal exams, and many women had vaginal exams (Seaward, 1997)

•         chorioamnionitis is minor

–        relative risk of endometritis: 0.30 (4 trials, N = 445) BUT

•         absolute difference [calculated from review data] 6.0%

•         Weakness: All women managed conventionally in hospitals therefore do not know what results would be with optimal care.

•         Conclusion: “Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices. (p. 2)”