Induction of Labour Verses Expected Management for Premature Rupture of Membrane an Experience

Abstract

Objective: To compare the maternal and perinatal outcome of active management of premature rupture of membrane with the expectant management for 12 hours followed by late induction if needed.

Methodology: This comparative study was conducted at Obs & gynae department of Muhammad Medical College Mirpur Khas, from July 2017 to December 2017. All cases of PROM with 37-41 weeks of gestation, single alive fetus, cephalic presentation and duration of PROM within 8 hours were included. Women were randomized into two groups. Women in active management group were induced with 3 mg prostaglandin E2 vaginal tablet, dinoprostone or oxytocin infusion depending on their Bishop scores. The failure of induction was defined as no appreciable or progressive increase in the cervical dilatation after more than 2 hours in the active phase of labour.

Results: Majority of the women 52.83% were multipara. Booked patients were 66% and un-booked were 34%. Neonatal infection did not differ significantly between the two groups i.e. 4% vs 5.33% (p- >0.05). In expectant management group 55.55% of caesarean sections were performed for meconium staining of liquor, 22.22% for failure of progress in 1st stage of labour and 11.11% for failure of induction. 61.35% of women went into spontaneous labour within 12 hours of expectant management and 29% of patients were induced after 12 hours Active intervention bas to be done in only 9.3% of patients. 06 of these developed suspected or established foetal distress and immediate delivery by caesarean section has to be performed in the face of poor Bishop Score. Two developed clinical signs of amnionitis and were induced immediately and delivered normally. Lesser number of women required augmentation in labour in active management group then in the expectant management group (0.001). Clinical chorioamnionitis ad post-partum fever were statistically insignificant in both management group (p >0.05).

Conclusion: No wide difference was observed between the two groups of management of PROM. Both the methods can be successfully employed for the management of term PROM. The choice of method should depend on the convenience of the obstetrician and will of the patients. Expectant management is more advantageous to Nulliparous women in term of more spontaneous deliveries and lesser operative vaginal deliveries.