A randomised controlled trial of immediate delivery versus expectant care in women with ruptured membranes close to term

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Preterm premature rupture of the membranes (PPROM) complicates 1-2% of all pregnancies and is the cause of 40% of all preterm births . At gestations remote from term expectant management is appropriate to allow fetal maturation. When PPROM complicates pregnancies closer to term the risks of prematurity are lower and the risk to the infant of sepsis becomes of greater significance. This trial will provide level 1 evidence from which to determine the optimum management of these women. If it can be demonstrated that early planned delivery in this clinical situation is associated with less maternal and neonatal morbidity this will change current national practice. The findings of the study will also have significant resource implications as PPROM close to term is a frequent indication for antenatal admission. The study also allows for a detailed assessment of the costs associated with the care of the neonate from two different management strategies. Analysis of the clinical and economic sequelae of immediate delivery as opposed to expectant management will enable informed decisions and guidelines to be formulated.