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Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial

van der Ham DP, van der Heyden JL, Opmeer BC, Mulder AL, Moonen RM, van Beek JH, Franssen MT, Bloemenkamp KW, Sikkema JM, de Groot CJ, Porath M, Kwee A, Woiski MD, Duvekot JH, Akerboom BM, van Loon AJ, de Leeuw JW, Willekes C, Mol BW, Nijhuis JG.

 Am J Obstet Gynecol, Oct 2012, 207(4):276.e1-10

Editor’s comment: Prof. Jim Thornton: 
Induction of labour does not reduce the risk of neonatal sepsis after PPROM near term.



The evidence for the management of near term prelabor rupture of membranes is poor. From January 2007 until September 2009, we performed the PPROM Expectant Management versus Induction of Labor (PPROMEXIL) trial. In this trial, we showed that in women with preterm prelabor rupture of membranes (PPROM), the incidence of neonatal sepsis was low, and the induction of labor (IoL) did not reduce this risk. Because the PPROMEXIL trial was underpowered and because of a lower-than-expected incidence of neonatal sepsis, we performed a second trial (PPROMEXIL-2), aiming to randomize 200 patients to improve the evidence in near-term PPROM.


In a nationwide multicenter study, nonlaboring women with PPROM between 34 and 37 weeks' gestational age were eligible for inclusion. Patients were randomized to IoL or expectant management (EM). The primary outcome measure was neonatal sepsis.


From December 2009 until January 2011, we randomized 100 women to IoL and 95 to EM. Neonatal sepsis was seen in 3 neonates (3.0%) in the IoL-group versus 4 neonates (4.1%) in the EM group (relative risk, 0.74; 95% confidence interval, 0.17-3.2). One of the sepsis cases in the IoL group resulted in neonatal death because of asphyxia. There were no significant differences in secondary outcomes.


The risk of neonatal sepsis after PPROM near term is low. Induction of labor does not reduce this risk.


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Commentaries by Editor Prof. Jim Thornton