A comparative study of feto-maternal outcome in expectant management versus active management in pre-labor rupture of membranes at term

Authors

  • Savitha T. S. Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
  • Pruthvi S. Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
  • Sudha C. P. Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
  • Vikram S. Nadig Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20175836

Keywords:

Induction delivery interval, Misoprostol, PROM

Abstract

Background: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 weeks of gestation and before the onset of the regular painful uterine contractions, complicates 5-10% of pregnancies, 80% of cases of PROM occur at term. It complicates the pregnancy leading to maternal and fetal complications, immediate risks such as cord prolapse, cord compression and placental abruptions, and later risks such as maternal or neonatal infection and the interventions such as caesarean section and instrumental vaginal delivery. These cases are either managed conservatively or by immediate induction of labour. Objective of present study is to compare the efficacy and safety of induction of labor versus expectant management at term PROM, in terms of maternal and fetal outcome.

Methods: A randomized control trial of 100 women coming to KIMSH from 01 /04 /2015 to 01 /05 /2016 with PROM at term with duration of leak ≤6 hours and a Bishop score ≤5 were assigned to group A immediate induction group and group B expectant management group with 50 cases in each group.

Results: The mean interval from PROM to delivery was significantly shorter in the induction Group 15.62±4.97 as compared with expectant group 17.58±4.78. Incidence of maternal morbidity and neonatal morbidity was comparable in both the groups. Intrapartum complications and mode of delivery were similar in both groups.

Conclusions: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval and hospital stay. Maternal morbidity and neonatal morbidity was comparable in both groups. It is concluded that immediate induction is better than expectant management. With active management many patients delivered vaginally within 24 hours without increase in the Caesarean section rate and decreased the need for oxytocin augmentation.

References

Duff P. Premature rupture of membranes in term patients: induction of labour versus expectant management. Clin Obstet Gynecol. 1998;41:883-91.

Bennett KA, Butt K, Crane JM, Hutchens D, Young DC. A masked randomized comparison of oral and vaginal administration of misoprostol for labour induction. Obstet Gynecol. 1998;92 (4 pt 1):48-6.

Ngai SW, Chan YM, Lam SW. Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with premature rupture of the fetal membranes. Br J Obstet Gynecol. 2000;107(2):222-7.

Javaid K, Tahira T, Hassan S. Management prelabour rupture of the membranes at term, induction of labour compared with expectant mangment. Professional Med J. 2008;15(2):216-9.

Lee M, Park W, Yoon H. Early rupture of membranes after the spontaneous onset of labour as a risk factor for caesarian delivery. Eur J Obstet Gynecol Reprod Biol. 2009;148:152-7.

Hannah ME, Ohlsson A, Farine D. Induction of labour compared with expectant management for prelabour rupture of the membranes at term. N Eng J Med. 1996;334(24):1005-10.

Nagpal M, Monika B, Chitra R. Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term. Int J Obstet Gynecol. 2009;106:23-6.

Shetty A, Stewart K and Stewarat G. Active management of term prelabour rupture of the membranes at term with oral misoprostol. Br J Obstet Gynecol. 2002;109(6):645-50.

Snehamay C, Nath MS, Kumar BP, Sudipta B. Premature rupture of membranes at term: immediate induction with PGE2 gel compared with delayed induction with oxytocin. J Obstet Gynaecol India. 2006;56:224-9.

Ayaz A, Saeed S, Farooq MU, Ahmad F, Bahoo LA, Ahmad I. Pre-labour rupture of membranes at term in patients with an unfavorable cervix: active versus conservative management. Taiwan J Obstet Gynecol. 2008;47:2.

Wing DA, Paul R and Jones M. Induction of labour with misoprostol for premature rupture of the fetal membranes beyond thirty six weeks gestation. Am J Obstet Gynecol. 1998;179(1):94-9.

Gibbs RS, Blanco JD, St Clair PJ, Castaneda YS. Quantitative bacteriology of amniotic fluid from women with clinical intra-amniotic infection at term. J Infect Dis. 1982;145:1-8.

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Published

2017-12-25

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Original Research Articles