Prelabor Rupture of the Membranes at Term

To the Editor: The study by Hannah et al. (April 18 issue) 1 exemplifies the best of evidence-based medicine: it is a multicenter, randomized, prospective trial with a large patient population and blinded outcome assessment. Despite the trial's methodologic and statistical strengths, the fact that the authors did not control for parity, cervical ripeness, digital vaginal examinations, or the use of oxytocin in their expectant-management group raises questions regarding the validity of their conclusions. The study fails to isolate and address the most vexing problem related to prelabor rupture of the membranes: how to care for a nulliparous woman with an . . .