Maternal Outcomes of Expectant Management In comparison with Induction of Labour within twenty four hours of Premature Rupture of Membranes (PROM).

Abstract

Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m² and in Group (B) it was 26.361 ±4.33 kg/m². In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.