Induction of Labor Compared with Expectant Management for Prelabor Rupture of the Membranes at Term

Hannah, Mary E.; Ohlsson, Arne; Farine, Dan; Hewson, Sheila; Hodnett, Ellen; Myhr, Terri L.; Wang, Elaine E. L.; Weston, Julie; Willan, Andrew R.

doi:10.1056/nejm199604183341601

Cited by 461 publications

(290 citation statements)

References 7 publications

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“…These results are in agreement with results obtained by Ngai et al and was supported with similar finding obtained by Javaid et al and Lee et al [3][4][5] In the present study, about 36% of patients in the expectant group went into spontaneous labour within 12 hours. These results are similar to the results obtained by Hannah et al (1996)6 and supported with similar finding obtained by Napgal et al and Shetty et al 7,8 Oxytocin was used in 18% of patients in the immediate induction group and in 44% of patients in the expectant management group for augmentation of labour after the onset of labour pain. This is similar to the results obtained by Chaudhuri Snehamay C et al who found that the rate of use of oxytocin during labor was 32.43% induction group and 82.14% in expectant group.…”

Section: Resultssupporting

confidence: 91%

“…6 There were no significant differences in the neonatal complications between the two groups. These results are in accord with results obtained by Shetty et al and supported by results obtained by Javaid et al 4,8 These results are in accord with results obtained by Wing et al and reinforced by Shetty et al and supported by results obtained by Javaid et al 4,8,11 In the present study, the major causes of neonatal morbidity were neonatal sepsis, hyperbilirubinemia, respiratory distress syndrome and birth asphyxia.…”

Section: Resultsmentioning

confidence: 78%

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

Savitha

Pruthvi

Sudha

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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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.

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Section: Resultssupporting

confidence: 91%

Section: Resultsmentioning

confidence: 78%

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

Savitha

Pruthvi

Sudha

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…In the case of active management of preterm rupture of membranes, the pooled random-effects odds (23) showed a large, statistically significant effect that was not apparent in any of the previous trials. In the case of elective induction of labor at term, the fixed-effect odds ratio for cesarean section changed from 0.40 to 0.84 between 1989 and 1992.…”

Section: Scatter and Predicted Range Of Relative Changes In The Treatmentioning

confidence: 65%

“…In the case of elective induction of labor at term, the fixed-effect odds ratio for cesarean section changed from 0.40 to 0.84 between 1989 and 1992. Subsequent trials, including a large one (23), have consistently given results showing a small benefit regarding this outcome. It is conceivable that the large treatment effect reported in the early trials may have been due to publication bias or publication lag (24).…”

Section: Scatter and Predicted Range Of Relative Changes In The Treatmentioning

confidence: 96%

Evolution of treatment effects over time: Empirical insight from recursive cumulative metaanalyses

Ioannidis¹

2001

Proceedings of the National Academy of Sciences

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Evidence on how much medical interventions work may change over time. It is important to determine what fluctuations in the treatment effect reported by randomized trials and their metaanalyses may be expected and whether extreme fluctuations signal future major changes. We applied recursive cumulative metaanalysis of randomized controlled trials to evaluate the relative change in the pooled treatment effect (odds ratio) over time for 60 interventions in two medical fields (pregnancy͞perinatal medicine, n ‫؍‬ 45 interventions; myocardial infarction, n ‫؍‬ 15 interventions). We evaluated the scatter of relative changes for different numbers of total patients in previous trials. Outlier cases were noted with changes greater than 2.5 standard deviations of the expected. With 500 accumulated patients, the pooled odds ratio may change by 0.6-to 1.7-fold in the immediate future. When 2000 patients have already been randomized, the respective figures are between 0.74-and 1.35-fold for pregnancy͞ perinatal medicine and between 0.83-and 1.21-fold for myocardial infarction studies. Extreme early fluctuations in the treatment effect were observed in three interventions (magnesium in myocardial infarction, calcium and antiplatelet agents for prevention of preeclampsia), where recent mega-trials have contradicted prior metaanalyses, as well as in four other examples where early large treatment effects were dissipated when more data appeared. Past experience may help quantify the uncertainty surrounding the treatment effects reported in early clinical trials and their metaanalyses. Early wide oscillations in the evolution of the treatment effect for specific interventions may sometimes signal further major changes in the future. mega-trials ͉ heterogeneity ͉ randomized trials R andomized trials and metaanalyses are often considered primary means for assessing the efficacy of medical interventions (1-4). However, clinical evidence evolves over time: new trials continue to be performed, replacing, updating, and supplementing the knowledge obtained from earlier ones. Heterogeneity (i.e., variability) among trial results is unavoidable. New trials may strengthen our prior beliefs about the magnitude of a treatment effect (i.e., how much a treatment works), or, in some cases, they may alter these beliefs or invalidate them. Several recent examples (5-8) have been encountered where large randomized trials reached entirely different conclusions when compared with metaanalyses of earlier trials of small or even large sample size on the same question. For example, recent large trials seemed to invalidate our prior beliefs about the efficacy of treatments such as magnesium salts and nitrates for reducing overall mortality in acute myocardial infarction (9) or aspirin (10) and calcium supplementation (11) for the prevention of preeclampsia during pregnancy. Prior expectations of 30-60% reductions in mortality and preeclampsia, respectively, based on early trials, were not confirmed.Important questions arise: Could we have anticipated th...

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“…3,4 If bishop score is less than 6 then cervix is considered unfavorable and its ripening is indicated prior to oxytocin infusion and artificial ruptured of a membranes to decrease failure rate of induction and risk of caesarean section. 5 Need of cervical ripening and induction should be considered when it is felt that the benefits of vaginal delivery out weight the potential fetal and maternal risk of induction. These issues should be discussed with the women in detail before initiation of induction.…”

Section: Introductionmentioning

confidence: 99%

Induction of Labor; Efficacy and Safety of Intravaginal Prostaglandin E2 Pessary

Baloch¹,

Jabeen²,

Zahiruddin³

et al. 2017

TPMJ

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Efficacy and safety of intra-vaginal prostaglandin E2 pessary for induction of Labor. Objectives: To evaluate the efficacy and safety of intra-vaginal prostaglandin E2 pessary for induction of Labor. Study Design: Case control study. Setting: Gynecological and obstetric ward of Liaquat University of Medical and Health Sciences Hospital, Hyderabad. Period: 14 Feb 2012 to 13 Feb 2013. Study Population: All the Pregnant women at term or post term admitted in gynae ward from 14th February 2012 to 13th February 2013. Results: 100 women recruited in the study, study carried out at Gynecological ward of Liaquat University of Medical and Health Sciences Hospital Hyderabad. Analysis of booking status listed in Table-I revealed that 68% (n = 68) were un-booked having no antenatal care and 32.0% (n = 32) were booked. There were no protocol violation, relation to the parity listed in Table-II showed maximum number of patients (n = 62) 62.0% Primigravida and (n = 38) 38.0% multigravidas were include. Age distribution is listed in Table-III maximum patients (n = 49) 49.0% at age between 26 -35 years, 35 (35.0%) were between 20 -25 years, 10 (10.0%) were >35 years and 06 (6.0%) patients were belong to less than 20 years. Regarding the gestational age 57 (57.0%) patients in our study presented between 37 -39 weeks of gestation. However, 47 (47.0%) patients were at 40 ->40 weeks of gestation showed in the ( Table-IV). Indication for cervical ripening and induction of labor is listed on Table-V commonest indication was pregnancy induced hypertension followed by prolonged pregnancy, and IUGR etc. Table-VI shows the Bishop score 30 (30.0%) had Bishop Score 2 -3, while 70(70.00%) had a bishop score 4-5. Table-VII shows induction-delivery interval, Greater number of women (66/100) delivered within 24 hours of start of induction. Table-VIII showed mode of delivery, majority of the women had normal vaginal deliveries 64.00 while 16 deliveries by assisted vaginal deliveries while in remaining 20 cases caesarean section done. Table-IX shows four babies had an Apgar score 4/10 at end of 1 min and 7/10 at end of 5 min, whereas 96 babies had an Apgar score of 9/10 in 1 min. The indications for caesarean section are shown in Table-X. There were 09(9%) cases of failed induction, 11 cases of a fetal distress (Meconium stained liquor). There was no increased incidence of neonatal sepsis or Chorioamniotis or puerperal sepsis in any of our patients. No perinatal morbidity or mortality or any severe maternal complications were noted while mild side effects were noted which is mentioned in (Table-XI). Conclusion: In developed countries prostaglandin E2 are widely used for ripening of unfavorable cervix in induction of labor but patient response vomiting, diarrhea, tachycardia, and fever are commonly observed minor side effects. Induction with Prostaglandin reduced the rate of pregnancies progressing beyond 41 weeks and related feto-maternal morbidity and mortality. After excluding contra indication all women should be offered induction at...

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Induction of Labor Compared with Expectant Management for Prelabor Rupture of the Membranes at Term

Cited by 461 publications

References 7 publications

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

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

Evolution of treatment effects over time: Empirical insight from recursive cumulative metaanalyses

Induction of Labor; Efficacy and Safety of Intravaginal Prostaglandin E2 Pessary

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