{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:15:54Z","timestamp":1747196154735,"version":"3.40.5"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material and methods<\/jats:title>\n<jats:p>This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count \u2265 15\u00d7100\/\u03bcL, C-reactive protein \u2265 1.5 mg\/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH &lt; 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection\/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261906","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T18:59:53Z","timestamp":1642100393000},"page":"e0261906","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5130-2266","authenticated-orcid":true,"given":"Francesco","family":"D\u2019Ambrosi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Cesano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Iurlaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Ronchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria Giuditta","family":"Ramezzana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Di Maso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Pietrasanta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Ronchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenza","family":"Pugni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Ferrazzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"pone.0261906.ref001","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1097\/AOG.0000000000003700","article-title":"Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"key":"pone.0261906.ref002","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1097\/00003081-199812000-00012","article-title":"Premature rupture of the membranes in term patients: induction of labor versus expectant management","volume":"41","author":"P. Dum","year":"1998","journal-title":"Clinical Obstetrics and Gynecology"},{"key":"pone.0261906.ref003","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1515\/jpm-2019-0297","article-title":"Evidence that intra-amniotic infections are often the result of an ascending invasion\u2014a molecular microbiological study","volume":"47","author":"R Romero","year":"2019","journal-title":"J Perinat Med."},{"key":"pone.0261906.ref004","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12884-016-0869-0","article-title":"Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births","volume":"16","author":"MA Davey","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0261906.ref005","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.clp.2010.02.003","article-title":"Diagnosis and management of clinical chorioamnionitis","volume":"37","author":"AT Tita","year":"2010","journal-title":"Clin Perinatol"},{"key":"pone.0261906.ref006","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ajog.2015.08.040","article-title":"Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance","volume":"213","author":"CJ Kim","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0261906.ref007","doi-asserted-by":"crossref","first-page":"4823404","DOI":"10.1155\/2018\/4823404","article-title":"Risk Factors for Neonatal Sepsis in Pregnant Women with Premature Rupture of the Membrane.","volume":"2018","author":"D Ocviyanti","year":"2018","journal-title":"J Pregnancy"},{"key":"pone.0261906.ref008","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/AOG.0000000000001246","article-title":"Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop","volume":"127","author":"RD Higgins","year":"2016","journal-title":"Obstet Gynecol"},{"key":"pone.0261906.ref009","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1056\/NEJM199604183341601","article-title":"Induction of labor compared with expectant management for prelabor rupture of the membranes at term. 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RANZCOG guidelines, March 2020."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T19:00:29Z","timestamp":1642100429000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261906"}},"subtitle":[],"editor":[{"given":"Martin G.","family":"Frasch","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,13]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261906","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2022,1,13]]}}}