Abstract
Background
Prelabor rupture of membranes (PROM) is a common obstetrical event, but its diagnosis is frequently challenging. The aim of the study was to determine whether equivocal PROM cases are associated with adverse outcomes.
Methods
A retrospective study was conducted in a tertiary medical center between July 2012 and March 2022. The cohort consisted of women diagnosed with term PROM (≥ 37 gestational weeks), divided into two groups: (1) certain PROM - suggestive history of a watery vaginal discharge confirmed by visualization of fluid leaking from the cervix or pooling in the vagina on speculum examination; (2) uncertain PROM - suggestive history of a watery vaginal discharge not supported by speculum examination. All patients were hospitalized and gave birth spontaneously or following either expectant management for up to 24 hours from PROM or induction. The primary outcome measure was cesarean delivery rate. Secondary outcome measures were adverse maternal and neonatal events.
Results
A total of 2012 women were included in the study, 1750 with certain PROM and 262 with uncertain PROM. The cesarean delivery rate was 5.8% in the certain PROM group and 8.8% in the uncertain PROM group; the difference was not statistically significant (p = .074). There was a significant between-group difference in the rate of cesarean delivery due to failed induction on univariate analysis (0.69% vs 2.67%, respectively, p = .007), but it was not maintained on multivariate logistic regression (OR 0.37, 95% CI 0.117–1.172). Other maternal and neonatal outcomes were similar in the two groups.
Conclusions
In our study, following the same management guidelines for equivocal cases of ruptured membranes as for confirmed cases of term PROM did not compromise maternal or fetal outcomes.