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

Abstract

INTRODUCTIONPre-labour rupture of the membranes (PROM) at term is defined as spontaneous rupture of the membranes after 37 weeks of the gestation before the onset of labor. PROM occurs in approximately 5-10% of all pregnancies, of which approximately 80% occur at term. 1In term PROM usually 70-80% goes into spontaneous onset of labor within 12 to 24 hours, and 95% within 48 to 72 hours. If the latent period exceeds 24 hours, the chances of infection increase. 2PROM is a common and important event in obstetrics. It has a major impact on fetal and maternal outcome, ABSTRACTBackground: 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.