On a midwife site I frequent,  it was mentioned that ACOG recently updated their policy on the care of a woman with PPROM (premature prolonged rupture of membranes).  Their most recent protocol is to induce "immediately" for PROM (premature rupture of membranes) rather than waiting 12--16--18--or 24 hours for natural labor to start.  This was not based on any new evidence according to this midwifery website.  As a homebirth midwife, I traditionally allow my ladies to wait up to 48 hours as long as there are no risk factors and no vag exams.  I remember doing an extensive read of the some of the literature and seeing some studies saying even 72 hours was safe with low-risk women and no vag exams.  What can you tell me about the research and can you come up with a possible/hypothetical reason why ACOG has changed its practice?

Recently, Mayri Sagady Leslie, CNM, did a guest blog on term PROM for Science and Sensibility that answers your question. Moreover, the Cochrane review on induction vs. expectant management of term PROM, which came out around the same time, reaches a very different conclusion: "Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices."

-- Henci