A 27-year-old primigravida at 39 weeks presents with spontaneous rupture of membranes 4 hours ago. She is not in labour, the vertex is engaged, and the CTG is normal. She asks whether waiting at home would reduce her chance of a cesarean. What does the evidence show regarding immediate induction versus expectant management in term PROM?

• A Expectant management reduces the cesarean rate
• B Immediate induction increases the cesarean rate significantly
• C Both approaches carry an equal risk of neonatal sepsis
• D Immediate induction does not increase the cesarean rate and reduces maternal and neonatal infection ✓

Explanation

The TERMPROM trial showed that immediate induction in term PROM does not raise the cesarean rate compared with expectant management, while shortening time to delivery and reducing chorioamnionitis and neonatal infection. This is why induction is the standard recommendation at term PROM. The tempting distractor is the belief that induction causes more cesareans; the trial specifically disproved this.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.