Oral misoprostol for induction of labor in prelabor rupture of membranes (PROM) at term: a randomized control trial

OBJECTIVE: To compare the efficacy of two different dosages of oral misoprostol (50 and 100 microg) with control, in medical induction of labor for patients with prelabor rupture of membranes (PROM) at term. METHODS: One hundred women with PROM at term were randomized to receive placebo (vitamin B6 50 mg, control), 50 microg (treatment group 1), or 100 microg (treatment group 2) of oral misoprostol every 4 h to a maximum of six doses. The main outcome measures included time interval from onset of PROM to delivery, duration of first stage of labor, and occurrence of vaginal delivery within 24 h from PROM. RESULTS: The time intervals from PROM to delivery were significantly reduced in both treatment groups compared to control (control, 25.1+/-10.5 h; treatment group 1, 14.5+/-6.2 h; and treatment group 2, 13.0+/-6.1 h, p<0.0001 for both). The duration of the first stage of labor was significantly shortened only in treatment group 2 compared to control (3.3+/-2.5 versus 6.2+/-3.4 h, p=0.01). Of those who delivered vaginally (93% in treatment group 1 and 97% in treatment group 2), significantly more women delivered within 24 h of PROM in the treatment group compared to the control group (50%, p<0.05). CONCLUSIONS: Oral misoprostol 50 microg every 4 h is safe, cheap, and as effective as 100 microg in reducing the PROM to delivery time interval and labor duration in primiparous women. The same effect is not observed in a multiparous group.     

足月及近足月胎膜早破临床最佳干预时机的探讨

目的 探讨妊娠35周以上胎膜早破孕妇的临床最佳干预时机. 方法对2005年1月1日至2009年12月31日在我院分娩的903例足月及近足月(孕周≥35周)、单胎头位且无其他合并症的胎膜早破孕妇的临床资料进行同顾性分析.按自然临产和缩宫素引产的不同时间分6组:1组为破膜后0～6 h自然临产孕妇269例;2组为破膜6～12 h自然临产孕妇161例;3组为破膜12～24 h自然临产孕妇75例;4组为破膜6～12 h未临产行缩宫素引产孕妇124例;5组为破膜12～24 h未临产行缩宫素引产孕妇98例;6组为破膜＞24 h未临产行缩宫素引产孕妇176例.分析各组孕妇的分娩结局及母婴并发症与破膜至分娩时间的关系. 结果 (1)903例胎膜早破孕妇中,破膜24 h内临床未干预的共681例,其中自然临产共505例,占74.2%.未干预者中430例在破膜12 h内自然临产,占63.2%,剖宫产率为20.7%(89/430);75例于破膜12～24 h自然临产,占11.0%,剖宫产率50.7%(38/75);176例破膜后24 h内仍未临产,占25.8%,剖宫产率为70.5%(124/176).(2)903例孕妇中破膜6、12、24 h行缩宫素引产者共398例(44.1%).破膜12 h缩宫素引产组(5组)的剖宫产率、宫内感染率、产褥病率和围产儿病率均低于破膜24 h缩宫素引产组(6组)[剖宫产率:52.0%(51/98)和70.5%(124/176);宫内感染率:6.1%(6/98)和22.7%(40/176);产褥病率:6.1%(6/98)和19.9%(35/176);围产儿病率:7.1%(7/98)和20.5%(36/176),P均＜0.01],但产后出血发生率两组之间比较差异无统计学意义[1.0%(1/98)和4.0%(7/176),P＞0.05]. 结论足月及近足月胎膜早破孕妇破膜12 h内自然临产率高,结局良好,故临床不必干预.破膜12 h仍未临产者,应积极引产.等待破膜24 h后再引产,则增加剖宫产率及母婴并发症的发生率.     

Contemporary diagnosis and management of preterm premature rupture of membranes

Spontaneous rupture of membranes (ROM) is a normal component of labor and delivery. Premature ROM (PROM) refers to rupture of the fetal membranes prior to the onset of labor irrespective of gestational age. Once the membranes rupture, delivery is recommended when the risk of ascending infection outweighs the risk of prematurity. When PROM occurs at term, labor typically ensues spontaneously or is induced within 12 to 24 hours. The management of pregnancies complicated by preterm PROM (defined as PROM occurring prior to 37 weeks of gestation) is more challenging. Preterm PROM complicates 2% to 20% of all deliveries and is associated with 18% to 20% of perinatal deaths. Management options include admission to hospital, amniocentesis to exclude intra-amniotic infection, and administration of antenatal corticosteroids and broad-spectrum antibiotics, if indicated. This article reviews in detail the contemporary diagnosis and management of preterm PROM.     

Oral misoprostol vs. placebo in the management of prelabor rupture of membranes at term.

OBJECTIVE: To evaluate the efficacy of oral misoprostol for the induction of labor (IOL) in women with prelabor rupture of membranes at term (PROM) and to monitor maternal or fetal complications. METHOD: This randomized, placebo controlled trial was performed in a secondary referral hospital. The data of 47 patients in the misoprostol--and 49 patients in the placebo group was available for analysis. The former received 100 microg misoprostol orally, repeated once after 6 h if not in active labor, the latter received two doses of vitamin C also after a 6-h interval. The Mann-Whitney U-test was used for analysis. RESULTS: The median treatment to delivery interval in the misoprostol group was 7.5 h and 25 h in the placebo group (P<0.001). No significant differences were found in the incidence of abnormalities on the cardiotocograph, mode of delivery, neonatal outcome, use of antibiotics for the mothers and patient acceptability. CONCLUSION: Oral misoprostol in the suggested dose is an effective and cheap alternative for IOL in patients with PROM. No adverse effects could be demonstrated.     

Comparative study of induction of labor in nulliparous women with premature rupture of membranes at term compared to those with intact membranes: duration of labor and mode of delivery

AIM: To evaluate the effect of premature rupture of membranes (PROM) at term on the duration of labor and mode of delivery in comparison with intact membranes in nulliparous women with an unfavorable cervix whose labor was induced. METHODS: This retrospective cohort study included all term nulliparous women with an unfavorable cervix requiring labor induction over a 2-year period. Prostaglandin E(2) (dinoprostone) and oxytocin were used for labor induction. Criteria for enrolment included (i) singleton pregnancy; (ii) term nulliparous women; or (iii) Bishop score below 6. Statistics were analyzed with Student's t-test, chi(2)-test, Fisher's exact test, and multiple logistic regression. RESULTS: Our study subjects were 82 women whose labor was induced for PROM and 219 women with intact membranes whose labor was induced for social or fetal reasons. The mean durations of active phase of labor were not significantly different between women with PROM and those with intact membranes. However, the women with PROM had a significantly longer mean duration of second stage and a higher rate of cesarean delivery for failure to progress than those with intact membranes. Multiple logistic regression demonstrated that only PROM and fetal macrosomia were significantly associated with an increased risk of cesarean delivery for failure to progress after other confounding variables were adjusted. CONCLUSIONS: Labor induction for PROM at term in nulliparous women with an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with intact membranes.     

胎膜早破的引产

综合考虑破膜原因、潜在风险等，近足月及足月胎膜早破（premature rupture of membrane，PROM）的引产较期待治疗更具积极意义。所有无阴道分娩禁忌证的PROM产妇均可考虑在破膜后2～12 h或24 h内进行引产。缩宫素、米索前列醇、地诺前列酮及机械性方法等均可用于PROM患者的引产，但在引产前应注意排除感染、头盆不称等不宜阴道分娩的情况，并根据患者产次、子宫颈Bishop评分选择更适宜的引产方法。引产过程中也应注意动态评估母儿状况和产程进展，进行个体化管理。     

Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial

AIM: To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. METHODS: We randomized 130 women with PROM of < or =4 h to either oral misoprostol, 50 microg, or a placebo given every 4 h for up to three doses. Intravenous oxytocin was initiated if active labor did not begin within 12 h. RESULTS: Sixty-four women received oral misoprostol and 66 received placebo. The PROM-to-delivery interval was shorter with misoprostol than with placebo (13.7+/-5.8 vs. 20.3+/-6.8 h, respectively, P<0.05). Misoprostol significantly reduced the need for oxytocin (28.1 vs. 72.7%, P<0.001) and antibiotics (25 vs. 69.7%, P<0.001). No significant differences in cesarean section or hyperstimulation rate were noted. CONCLUSION: Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics.     

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

Introduction

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.

Material and Methods

Singleton pregnancy cases with cephalic presentation reported between 37 and 41 weeks of pregnancy with PROM of <6 h and cervical dilatation <3 cm were studied over a period of 2 years. Out of 100 patients studied, half of them were managed by expectant protocol and the other half by early induction within 6 h 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.

Results

PROM–delivery interval was 22 h in expectant group, while in early induction group, it was 13 h (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.

Conclusion

Immediate labor induction with prostaglandin in cases of term PROM shortens delivery interval and maternal hospital stay with reduction in maternal–neonatal sepsis.     

Induction of labor in patients with term premature rupture of membranes. Effect on perinatal outcome.

OBJECTIVE: To determine whether delayed induction of labor in patients with premature rupture of membranes (PROM) at term has beneficial effects on the mother or the infant. STUDY DESIGN: Retrospective analysis of our database revealed 576 patients >37 weeks of gestation with PROM, who delivered live-born infants without major congenital anomalies. We analyzed the frequencies of primary cesarean, neonatal intensive care unit (NICU) admissions, and oxytocin use by time since hospital admission and interval until onset of labor. RESULTS: NICU admission increased from 1.9% in <3 h between admission to onset of labor to 13.3% after >18 h. Admission-onset of labor interval, birth weight of <2,500 or >4,000 g and meconium were all more important determinants of NICU admission than gestational age, duration of labor, PROM, and ROM. Prolonged admission-onset of labor interval was associated with an increased risk of variable decelerations (p < 0.001). Primary cesarean rates increased progressively with longer intervals between admission and onset of labor. Stepwise discriminant function analysis revealed that labor duration, admission-onset of labor interval, gestational age, and birth weight of <2,500 g were all more important determinants of primary cesarean delivery than the durations of PROM or ROM. CONCLUSIONS: The increased frequencies of NICU admission, variable decelerations, and primary cesarean suggest that delayed labor induction after hospital admission was linked to worsened perinatal outcomes. These results may have been influenced by usually performing a single digital examination as part of initial evaluation of term patients who present with PROM. Based on our data, we suggest immediate induction for PROM at term, especially if digital examination has been performed.     

Premature rupture of membranes at term in nulliparous women: a hazard?

One hundred five consecutive women with premature rupture of the membranes (PROM) at term were managed expectantly for at least 24 hours. Seventy-six went into spontaneous labor, of whom 38 were augmented with oxytocin. Twenty-nine had labor induced. Subjects who delivered during the same study interval after artificial rupture of the membranes served as controls. There were no statistically significant differences in the frequency of amnionitis, endometritis, cystitis, neonatal infection, low Apgar score, low cord arterial blood pH, instrumental delivery, or cesarean delivery. Morbidity was seen most often in induced labor whether or not the membranes were ruptured for a long time. It is concluded that expectant management of PROM at term does not increase perinatal morbidity.     

A retrospective review of the efficacy and safety of prostaglandin E2 with premature rupture of the membranes at term.

OBJECTIVE: The purpose of this study was to assess rates of endometritis, clinical chorioamnionitis, cesarean delivery, and neonatal sepsis from the records of patients with premature rupture of the membranes (PROM) and an unfavorable cervix treated with vaginal prostaglandin (PG) E2 in comparison with those in the literature. METHODS: Using a computer data base at Denver General Hospital, we identified 146 women with PROM and cervical dilatation of 2 cm or less at term who were treated with PGE2 gel or suppositories. The records were reviewed to identify rates of maternal and neonatal infection and complications, as well as cesarean delivery. RESULTS: The cesarean rate was 12%. Chorioamnionitis developed in 6.8% of the study group and endometritis in 2%. Neonatal complications were limited to two with low Apgar scores (less than 7 at 5 minutes), one with microbiologically confirmed sepsis, and two with positive urine counterimmunoelectrophoresis for group B streptococcus. The only instance of neonatal sepsis occurred in a patient with rupture of membranes longer than 24 hours. CONCLUSIONS: The use of vaginal PGE2 suppositories for induction of labor and cervical ripening in term patients with PROM was accompanied by a high rate of vaginal delivery and a low rate of maternal and neonatal complications in a city hospital setting.     

Induction of labour with a favourable cervix and/or pre-labour rupture of membranes

Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant management, results in a reduced risk of chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin, prostaglandin induction results in a lower rate of epidural use and internal fetal heart rate monitoring but a greater risk of chorioamnionitis, nausea, vomiting, more vaginal examinations, neonatal antibiotic therapy, NICU admission and neonatal infection. Women should be informed of the risks and benefits of each method of induction.Misoprostol is gaining increasing interest as an alternative induction agent. It appears to be an effective method of labour induction with term PROM. Further research is needed to identify the preferred dosage, route and interval of administration, and to assess uncommon maternal and neonatal outcomes.There has been limited research on the use of prostaglandins, including misoprostol, for induction of labour with a favourable cervix and intact membranes. Compared with intravenous oxytocin (with and without amniotomy), labour induction using vaginal prostaglandins in women with a favourable cervix (with and without PROM) results in a higher rate of vaginal delivery within 24 hours and increased maternal satisfaction. In women with a favourable cervix, artificial rupture of membranes followed by oral misoprostol has similar time to vaginal delivery compared with artificial rupture of membranes followed by oxytocin. Further research with prostaglandins, including misoprostol, is needed to evaluate other maternal and neonatal outcomes in women being induced with a favourable cervix.No form of prostaglandin induction in women with PROM or favourable cervix has proven clearly superior to oxytocin infusion.     

Prelabor rupture of membranes at term: induction techniques

The clinical management of premature rupture of membranes (PROM) at term has been a matter of considerable controversy. Management options have included expectant management or induction of labor with oxytocin, dinoprostone (PGE2), or misoprostol. Early studies suggested that immediate oxytocin induction of labor might reduce maternal and neonatal infections while increasing risk for cesarean section. The definitive TermPROM study found no difference in neonatal infections between immediate and delayed induction with oxytocin and PGE2. However, neither PGE2 nor delayed induction resulted in fewer cesarean sections than immediate oxytocin. Misoprostol offers several theoretical advantages over oxytocin in the setting of PROM at term. However, randomized trials to date have found no significant advantage for misoprostol administration compared with other agents for women with PROM.     

Prelabor rupture of membranes at term in low-risk women: induce or wait?

Objective: To compare the outcomes of expectant versus induction of labor management of patients presenting with prelabor rupture of membranes (PROM) at term. Study design: Observational case–control study over a period of 36 months. Setting: King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Subjects: All obstetric patients with no obstetric risk factors, other than PROMs at term, were included in our study. Each patient was matched with a control case, whose labor started with intact membranes. Outcome measures: Length of labor duration, fetal distress, intrapartum pyrexia, rate of cesarean delivery, and Apgar scores at birth. Results: The length of labor duration was shorter in patients with PROMs at term compared to the control group, but the difference was not statistically significant. Furthermore, cesarean section (CS) rate was 4.5% in the PROMs group versus 5.5% in the control group. Among patients with PROM who received induction of labor management, the rates of intrapartum pyrexia and CS were almost twice than in patients who were managed expectantly. However, the differences were not statistically significant. Conclusion: In the absence of other obstetric and maternal or fetal risk factors, PROMs at term does not seem to constitute additional obstetric risks. Furthermore, expectant management of PROM at term enhances the patient’s chance of normal vaginal delivery without an increase in fetal and/or maternal morbidity.     

Role of prostaglandin in the management of prelabour rupture of the membranes at term.

OBJECTIVE: To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term. DESIGN: A prospective randomized study. SETTING: Labour Ward, Aberdeen Maternity Hospital. SUBJECTS: 230 primigravidae at terms with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. INTERVENTIONS: In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses. MAIN OUTCOME MEASURES: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. RESULTS: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section. CONCLUSION: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.     

No benefit from conservative management in nulliparous women with premature rupture of the membranes (PROM) at term. A randomized study.

OBJECTIVE. To compare maternal and fetal outcome in pregnancies with premature rupture of the membranes (PROM) at term with either early induction of labor or conservative management awaiting spontaneous labor. DESIGN. A prospective randomized trial. SETTING. The University Hospital of Lund, Sweden. SUBJECTS. Altogether 369 women with singleton pregnancy, cephalic presentation, gestational duration 36-41 weeks, were randomized either to induction of labor (n = 139) or conservative management up to 3 days (n = 138). Those eligible but not participating in the study totalled 92. MAIN OBSTETRIC MEASURES. Obstetric intervention rate (cesarean section or instrumental delivery) and short-term neonatal morbidity. RESULTS. No difference was found in the rate of obstetric intervention between the induction of labor group and the group with conservative management (12.2 vs. 18.8%; chi 2 = 2.3, p greater than 0.05). A slightly increased rate of neonatal infections was seen in the latter group (0.7 vs. 4.3%; chi 2 = 3.2, p less than 0.05). CONCLUSIONS. We found no benefit from conservative management for up to 3 days in women with PROM at term, compared with immediate induction of labor. There was no difference in the number of obstetric interventions during labor. The neonatal infectious morbidity was slightly higher in conservatively managed cases.     

A study of 579 pregnant women with premature rupture of membranes at term

Objective

To determine the best management for women with premature rupture of membranes at term.

Method

In 2008, 579 women admitted to Peking University First Hospital for premature rupture of membranes (PROM) at term were allocated to one of 3 groups. Group 1 (n = 292) consisted of those whose labor began spontaneously within 12 hours of PROM; group 2 (n = 234), of those whose labor did not begin within 12 hours of PROM and were induced with oxytocin; and group 3 (n = 53), of those who accepted a cesarean delivery immediately after PROM was diagnosed. The χ² test was used to compare the rates of intrauterine and neonatal infection in these 3 groups.

Results

Compared with the intrauterine and neonatal infection rates for group 1 (3.4% and 13.7%) and group 3 (1.9% and 3.8%), the corresponding rates were higher for group 2 (10.7% and 21.8%) (P < 0.05). In group 2, 76.5% of the women began labor within 24 hours of induction and 92.7% of these within 12 hours.

Conclusion

In women at term, induction should be performed immediately after PROM is diagnosed, as it is likely to fail when labor does not begin within 12 hours of oxytocin administration.     

Intravaginal misoprostol vs. expectant management in premature rupture of membranes with low Bishop scores at term.

OBJECTIVES: To evaluate the efficacy of vaginal misoprostol for cervical ripening and labor induction in premature rupture of membranes (PROM) cases with low Bishop scores at term. METHODS: Sixty-two PROM cases who fulfilled the criteria of 36 weeks of completed gestation, not in active labor, singleton pregnancy with vertex presentation, normal fetal heart rate reactivity, amniotic fluid index >5 cm and Bishop score <5, consented to participate in the study. Thirty-one of the cases were included in study group and a 50-microg misoprostol tablet was placed in the posterior vaginal fornix. Another 31 cases were included in control group and managed expectantly. Treatment success was defined as an interval from membrane rupture to delivery of <24 h. RESULTS: The mean admittance-delivery interval was significantly shorter in the study group (8.68+/-4.40 h) compared with the control group (26.22+/-18.98 h, P=0.001) and the mean interval from membrane rupture to delivery were also significantly shorter in the study group (19.37+/-7.20 h) than the control group (33.05+/-20.85 h, P=0.001). Oxytocin necessity was significantly lower in the study group than the control group (45.2% vs. 100%, P=0.00051). Tachysystole occurred more frequently in the study group (8 cases, 25.8% vs. 2 cases, 6.5%, P=0.038). There were no difference between two groups with regard to birth weights, 1- and 5-min Apgar scores and the need for neonatal intensive care unit. CONCLUSIONS: It is effective, safe and economic to use misoprostol vaginally in PROM cases with low Bishop scores at term.     

Predictors of cesarean delivery after prelabor rupture of membranes at term.

OBJECTIVE: To identify the significant predictors of cesarean delivery after prelabor rupture of membranes (PROM) at term. METHODS: In a multicenter study involving 72 institutions in six countries, 5041 women were randomized to induction of labor with oxytocin or prostaglandins or to expectant management. We did univariate and multivariate logistic regression analyses to determine the statistically significant independent predictors of cesarean delivery (P < .05). RESULTS: The following variables were found to be significantly associated with cesarean delivery: delivery in Israel, versus Canada (odds ratio [OR] 0.34); delivery in Australia, versus Canada (OR 1.93); nulliparity (OR 2.81); labor lasting more than 12 hours, versus less than 6 hours (OR 2.78); labor lasting 6-12 hours, versus less than 6 hours (OR 1.66); previous cesarean delivery (OR 2.75); epidural anesthesia (OR 2.66); clinical chorioamnionitis (OR 2.42); internal fetal heart rate monitoring (OR 2.19); birth weight of at least 4000 g (OR 2.07); use of oxytocin (OR 1.97); maternal age of at least 35 years (OR 1.44); latent period of at least 12 hours (OR 1.41); and meconium staining (OR 1.41). CONCLUSION: Strong predictors of cesarean delivery after PROM at term were country of birth, nulliparity, long labor, previous cesarean delivery, and epidural anesthesia.     

Effect of routine weekly cervical examinations at term on premature rupture of the membranes: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to determine whether routine antepartum cervical examinations at term are associated with premature rupture of membranes (PROM). METHODS: This was a randomized controlled trial conducted at a health maintenance organization in metropolitan Denver. The subjects were 604 term gravidas randomized to a no examination or examination group. Exclusions included preterm labor, third-trimester bleeding, cerclage, multiple pregnancy, history of PROM (rupture before the onset of labor), and planned induction or cesarean. In the no examination group, routine examinations (without clinical indication) were not performed. In the examination group, weekly examinations were performed from 37 weeks until delivery. RESULTS: No statistically significant difference in PROM or prolonged PROM (more than 6 hours) was observed between those unexposed and those exposed to routine cervical examinations at term. In addition, there were no differences between the groups in other relevant outcomes including cesarean delivery, induction, augmentation, chorioaminionitis, or neonatal infectious morbidity. CONCLUSION: In our population, there is no association between routine weekly antepartum cervical examinations at term and PROM or other study end points.