"PROM"

ACTIVE MANAGEMENT AT TERM WITH ORAL MISOPROSTOL

Abstract

Objective: To assess and compare the number of subjects in both groups (Study and comparison), who went into active labour
within 24 hours and to compare the various complications (maternal & fetal) in both groups. Study Design: Quasi experimental. Sampling Technique: Convenience sampling. Sample Size & Setting: A total of 100 pregnant women presenting with history of leaking amniotic fluid at term (>37 wks) to labour ward of obstetrics and Gynaecology unit, Bahawal Victoria Hospital, Bahawalpur were included in the study. Material & Method: The pregnant women fulfilling the inclusion criteria were enrolled as our study subjects. Rupture of membranes was confirmed by nitrazine test.The
patients were randomized into two groups (50 women in study and 50 in comparison group). In study group, 50 (Ligm of misoprostol was given
orally after initial assessment of mother and fetus. The dose was repeated 4 hourly, if there was no uterine activity. The number of patients going into active labour and delivering within 24 hours were noted. Different complications (maternal & fetal) faced during all procedure were also recorded and managed. In comparison group, patients were managed were also recorded and managed. In comparison group, patients were managed conservatively for 24 hours. Like in study group, number of patients gong into active labour and delivering with in 24 hours were noted. Different maternal & fetal complications occurring in this group were also recorded and managed. Results: A total of 100 Pregnant women were included in the study. The sample size (100 patients with PROM at term) was completed in 5 months. During that period over all 1105 deliveries were conducted, so the incidence of PROM at term in the study was 9.4%. It was observed in the study group, that all the patients (100%) went into active labour and 96% were delivered within 24 hours of PROM. While in comparison group 72% patients went into active labour and only 62% were delivered within 24 hours of PROM. The results showed that in study group 36 patients went into active labour with only one dose of oral misoprostol, 9 patients required 2 doses and 5 patients required 3 doses of oral misoprostol for going into active labour. When maternal complications were compared in both groups, 92% patients in study group had no complication while only 8% patients had to face different complications. In comparison group 86% had no complication and in 14% patients different complications occurred. Regarding fetal complications 4% fetus/neonates had to face different complications in each group. In current study there was no significant difference in the mode of delivery between the two groups. Conclusion: It was concluded that active management of pre labour rupture of membrances at term with oral misoprostol is a better option than the expectant management. Oral misoprostol in dose of 50 jugm is an effective agent for cervical ripening and induction of labour in PROM at term as significantly high percentage of patients delivered within 24 hours with no increase in maternal and fetal complications.