Induction Versus Expectant Management Between 34 to 37 Weeks Gestation With Preterm Prelabour Ruptures of Membrane: Aprospective Randomised Controlled Study in a Peripheral Medical College, India.

Abstract

Aims & Objective: To compare Feto-maternal outcome in induction versus expectant management in women with singleton pregnancy without any complication with preterm prelabour rupture of membranes between 34 to 37 weeks gestation. Materials & Methods: It was a hospital based prospective clinical observational study.100 women with singleton pregnancy between 34 to 37 weeks of gestation was selected. Randomization was done 1: 1 ratio for induction or expectant management. Women with odd numbers (1,2,3 etc) was allocated for induction of labour. Labour was induced according to the local protocol within 12 hours after randomization. Women with even numbers (2,4,6 etc) were allocated for expected management and was monitored according to standard local protocol until delivery started spontaneously. Result: There was no significant difference in mean age, parity, booking status in both group but rate of caesarean section was lower in induction group (28%) than expectant group (32%), mean randomization to delivery interval was more in expectant group (42 hours) compare to induction group (20 hours). Chorioamnionitis was 10% versus 34% and statistically significant (p value 0.0251). Foetal distress seen in 22% versus 24% in induction vs expectant group. Incidence of postpartum fever was more in expectant group than induction group (32% versus 5%) and statistically significant (p value 0.0141). Better Apgar scores at 1 minute (p value 0.0141) and 5 minutes (p value 0.0007) was in induction group as compared to expectant group. Rate of neonatal intensive care unit admission in induction group (40%) was lower than expectant group (64%) and p value 0.0277. No significant difference seen in incidence of low birth weight in both groups. Rate of neonatal death was lower in induction group (2%) than expectant group (8%). Conclusion: In this study it was observed that induction of labour in case of preterm prelabour rupture of membrane between 34 to 37 weeks leads to better Feto-maternal outcomes in terms of better Apgar scores, lesser neonatal intensive care unit admission, lower randomization to delivery interval , reduced chance of developing chorioamnionitis along with decreased incidence of postpartum fever as compared to expectant management. Hence active management by induction of labour in preterm prelabour rupture of membrane is better line of management & recommended as per our study result.