Introduction: Prelabour rupture of membranes at term affects approximately 10% of women during
pregnancy, and it is often associated with a higher risk of infection than when the membranes are intact. In an
attempt to control the risk of infection, two main approaches have been used most widely in clinical practice:
induction of labour (IOL) soon after the rupture of membranes, also called active management (AM), and
watchful waiting for the spontaneous onset of labour, also called expectant management (EM). In addition,
previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis. However,
the effect of vaginal examinations in the context of prelabour rupture of membranes have not been researched
to the same extent.
Methods: This systematic review analyses and critiques the latest research on the management of term
prelabour rupture of membranes, including the effect of vaginal examinations during labour, with a focus on
the outcomes of both normal birth, and chorioamnionitis. Due to its complexity, three research questions were
identified using the PICO diagram, and subsequently, the results from these searches were combined. The
systematic review aimed to identify randomised controlled trials (RCTs) and observational studies that
compared active vs expectant management, included number of vaginal examinations and had chorioamnionitis
and/or normal birth as outcomes. The following databases were used: MEDLINE, EMBASE, Maternity and
Infant care, LILACS, CINAHL and the Cochrane Central Register of Controlled trials. Quality was assessed
using a tool developed especifically for this study that included questions from CASP and the Cochrane risk of
bias tool. Due to the high degree of heterogeneity meta-analysis was not deemed appropriate. Therefore,
simple narrative analysis was carried out.
Results: 32 studies met the inclusion criteria, of which 27 were RCTs and 5 observational studies. The overall
quality of the studies wasn’t high, 15 out of the 32 studies were deemed to be low quality and only 17 out of
32 studies were deemed to be of intermediate quality. The systematic review revealed that the management of
term prelabour rupture of membranes continues to be controversial. Previous research has compared active
management (Induction of labour shortly after the rupture of membrane) against expectant management
(watchful waiting for the spontaneous onset of labour). Although previous studies have demonstrated that
vaginal examinations increase the risk of chorioamnionitis, no prospective studies have included an intervention
to reduce the number of vaginal examinations.
Conclusion: A RCT assessing the consequences of active management and expectant management as well as
the effect of vaginal examinations during labour for term prelabour rupture of membranes is necessary.