Mercer 1993.

Methods	RCT Duration of study: 1 March 1991‐31 July 1992
Participants	Setting: University of Tennessee, Memphis, USA Participants: 93 women 46 women were randomised to induction of labour 47 women were randomised to expectant management Inclusion criteria Confirmed premature rupture of the membranes at 32 weeks‐36 weeks 6 days Amniotic fluid testing suggestive of fetal pulmonary maturity Exclusion criteria Cervical dilatation greater than 2 cm Persistent regular contractions or progressive labour Blood or meconium‐stained amniotic fluid Suspected chorioamnionitis Any maternal or fetal contraindication to expectant management Women with fetuses with intrauterine growth restriction Women with fetuses with congenital malformations A non‐reassuring fetal heart rate tracing (defined as recurrent decelerations, heart rate greater than 160 beats per minute, or the absence of heart rate accelerations)
Interventions	Intervention: intravenous oxytocin infusion Control: expectant management This included 12 h of continuous fetal heart rate monitoring Observations performed every 8 h Women restricted to bed rest Criteria for delivery included progressive labour chorioamnionitis (defined as a temperature > 100.4°F plus any 2 of the following: fetal or maternal tachycardia, uterine contractions or tenderness, foul smelling amniotic fluid in the absence of other identifiable cause) non‐reassuring fetal heart rate pattern including persistent fetal tachycardia or recurrent deceleration and positive cultures for Neisseria gonorrhoeae or GBS Corticosteroids, tocolysis and prophylactic antibiotics not used Vaginal examinations not performed in the absence of labour
Outcomes	Maternal Latency from randomisation to labour Latency from randomisation to delivery Duration of maternal hospital stay Chorioamnionitis: T > 100.4°F plus 2 of the following: fetal or maternal tachycardia uterine contractions or tenderness foul‐smelling amniotic fluid in the absence of other identifiable cause Caesarean delivery Postpartum infection requiring antibiotics Fetal Neonatal sepsis: required a positive culture for diagnosis subgrouped into suspected and confirmed sepsis: suspected neonatal sepsis: clinical findings suggestive of neonatal infection or persistent leucopenia with a WBC count < 4000/mm3 or a C‐reactive protein level elevated greater than 0.6; confirmed neonatal sepsis: infants with symptoms of sepsis and positive blood cultures Abnormal fetal heart rate pattern Birthweight Apgar scores Respiratory distress: required oxygen therapy (at least 40%) at least 24 h in absence of other identifiable cause Pneumonia Necrotising enterocolitis Intraventricular haemorrhage Duration of neonatal hospital stay Mortality
Notes	Gestational age: determined clinically on the basis of menstrual history, earliest ultrasound examination and first clinical assessment Ruptured membranes diagnosed by: visualisation of amniotic fluid passing from the cervical os on sterile speculum examination or the presence of a pool of fluid in the posterior vaginal fornix that was positive to both Nitrazine paper and ferning tests Fetal pulmonary maturity was determined on pooled vaginal fluid (foam stability index ≥ 47 considered mature), an amniocentesis was performed in the absence of adequate vaginal fluid.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random number tables
Allocation concealment (selection bias)	Unclear risk	Not clearly defined. Stated that "blinded" random number tables were used, but no further explanation was given as to what this entailed.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Blinding not possible due to intervention. However this was likely low risk of bias due to objective and specific assessment criteria for outcomes, where lack of blinding did not affect treatment decisions or other aspects of care.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Neonatologists were not blinded to the perinatal clinical course. It was not specified whether the assessors of maternal outcomes were blinded to their clinical course.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses to follow‐up or post‐randomisation exclusions
Selective reporting (reporting bias)	Unclear risk	Outcomes only reported in results. Not pre‐specified
Other bias	Low risk	None noted