Early induction versus expectant management in prelabour rupture of membranes
Keywords:Induction of Labour, Neonatal sepsis, Oxytocin, Prelabour rupture of membranes, PGE2 Gel
Background: Prelabour rupture of membrane defined as spontaneous rupture of membrane prior to the onset of regular uterine contractions. The incidence of PROM varies from 6-18%. Management of term PROM is not having specific guidelines leading to management dilemma.
Methods: This prospective study was conducted on 100 women with singleton pregnancy, cephalic presentation with spontaneous PROM at term. The aim to compare maternal and perinatal outcome of early induction with expectant management in women with PROM. The patients were divided into two group expectant group and early induction group. Induction of labour was done by PGE2 gel and expectant group patient were observed for 24 hours for spontaneous labour since leaking. Augmentation of labour was done with Oxytocin if required. Outcomes were measured as PROM to delivery interval, induction to delivery interval, mode of delivery, maternal and neonatal morbidity.
Results: Eighty percent of women of expectant group went into active labour within 24 hours, and all patient of induction group went into active labour in 18 hours (p<0.001). ROM to active labour interval and ROM to delivery interval were significantly less in early induction group, (9.87 and 17.212 hour) compared to expectant group (19.118 and 23.34-hour, p<0.001). Fetal distress and LSCS were comparatively higher in induction group (16%vs 2% p=0.038). Neonatal Sepsis was seen more in expectant group but statistically insignificant (22% versus 16%, p=0.26).
Conclusions: Women with term PROM can be given informed choice of expectant management and early induction explaining the merits and demerits of both options.
Gunn GC, Mishell DR Jr, Morton DG: Premature rupture of fetal membrane at term. A review: Am J Obstet Gynecol. 1970;106(3):469-83.
Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned earl birth versus expectant management (waiting) for Prelabour rupture of membrane at term (37 week or more). Cochrane Database of syst Rev. 2006; 1:CD005302.
Duff P. Premature rupture of the membranes in term patients. Semin Perinatol. 1996;20(5):401–8.
Reece EA, Chervenak FA, Moya FR, et al: Amniotic fluid arborization: Effect of blood, meconium, and pH alterations. Obstet Gynecol. 1984;64(2):248.
Larranaga-Azcarate C, Campo-Molina G, Perez-Rodrı´guez AF, Ezcurdia-Gurpegui M. Dinoprostone vaginal slow release system compared to expectant management in the active treatment of premature rupture of the membranes at term: impact on maternal and fetal outcome. Acta Obstetrica. 2008; 87(2):195–200.
Parson M, Spellacy W. Premature Rupture of membranes, Danforth’s Obstetrics and Gynaecology, editor James R. Scott et al; Lippincott Williams and Wilkins, 8th Edition:1999;269-76.
Induction of labour - NICE clinical guideline 70 - NHS Choices Available at https://www.nhs.uk/planners/pregnancycareplanner/.../nice_induction_of_labour.pdf
Idem. Prostaglandins for prelabour rupture of the membranes at 34 + weeks. In: Enkin M, Keirse MJNC, Renfrew MJ, Neilson JP, eds. Chochrane pregnancy and childbirth database. Oxford, England: Cochrane, 1993. (Review no. 07154.) (Software.)
Song J. Use of misoprostol in obstetrics and gynecology. Obstet Gynecol survey. 2000;55(8):503-10.
Krupa S, Doshi H. Premature Rupture of Membrane at Term: Early Induction Versus Expectant Management; J Obstet Gynaecol India. 2012; 62(2):172-5.
Chaudhary S, Mitra SN, Biswas PK, Bhattacharyya S: Premature Rupture of membranes at term: immediate induction with PGE2 Gel compared with Delayed induction with oxytocin: J Obstet Gynaecol India. 2006;56(3):224-9.
Bangal VB, Gulati P, Shinde KK, Borawake SK: Induction of labour versus expectant management for premature rupture of membranes at term: IJBR 2012;3(3):164-70.
Kodkany BS, Telanga MA: Premature rupture of membranes: A study of 100 cases: J Obstet Gynaecol India 1991:41(4):492-6.
Aryal S, Karki C. Induction of Labour in Prelabour Rupture of Membranes with or without Cervical Ripening with Prostaglandin E2: J Lumbini Med College. 2014;2(1):4-9.
Vaishnav J, Vaishnav G. A study of feto-maternal outcome in patients with pre-labour rupture of membranes at term (>37 weeks). Med Sci. 2011;1(2):118-24.
Poornima B, Reddy DD. Premature rupture of membranes at term: immediate induction with PGE 2 gel compared with delayed induction with oxytocin. J Obstet Gynecol India. 2011 Oct 1;61(5):516-8.
Rawat R, Divedi P, Debbarma S, Vishwakarma S, Mittal N. A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population: Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2393-8.