A COMPARATIVE STUDY OF FOETOMATERNAL OUTCOME IN EXPECTANT VERSUS ACTIVE MANAGEMENT OF PRELABOUR RUPTURE OF MEMBRANES AT TERM

Abstract

Background: Premature rupture of the membranes (PROM) at term is a significant cause of maternal complica-tions, increased operative procedures, neonatal morbidity and mortality. If the latent period exceeds 24 hours, the chances of infection increase. The management strategies are waiting for spontaneous onset of labour (expectant management) or induction of labour with prostaglan-dins/oxytocin (active management).

Objective: To find out the maternal and perinatal outcome following active and expectant management of prelabour rupture of membranes at term and to compare their outcome.

Materials and methods:Two hundred term antenatal women with PROM in the Department of Obstetrics and Gynaecolo-gy, AMCH, Dibrugarh were recruited for study. One hundred women received immediate induc-tions (Group A) with vaginal misoprostol, while another 100 antenatal women were expectantly managed (Group B) for 12 hours, following which induction of labour was started as per re-quirement. The primary outcomes were latency period, PROM delivery interval. Secondary outcome measures were maternal and neonatal morbidities.

Results:The mean latent period was significantly shorter in the induction group 9.20+7.76 hours as compared with expectant group, 12.70+6.20 hours with a p value of 0.005. Similarly, the mean interval from PROM to delivery was significantly shorter in the induction group, 14.03 + 7.55 hours as compared with expectant group, 18.03+7.37 hours with p value 0.0003. Incidence of maternal morbidity and neonatal morbidity were similar in both the groups. Intrapartum complica-tions and mode of delivery were similar in both groups.

Conclusion:Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any significant increase in caesarean section rate as compared to expectant management group.

Keywords:Prelabour rupture of membranes; Induction of labour; Latent period; PROM delivery interval