A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population

Abstract

INTRODUCTIONPremature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions.1 PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. 2 The aetiology of PROM is multifactorial. 2At term, PROM can be physiological variation rather than a pathological event. PROM occurs when intrauterine pressure overcomes membrane resistance.This happens due to weakening of membranes either congenital or acquired (smoking and vitamin C deficiency), or because of damaging factors either mechanical during amniocentesis or damage by infection (Trichomonas infection, group B streptococci, bacterial vaginosis). Failure of mechanical support such as cervical dilatation can lead to premature rupture of membrane. 3Other etiological factors are overdistended uterus, big baby, polyhydramnios and multiple pregnancy. Methods:The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis. Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups. Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group.

Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery

“…Some obstetricians recommend immediate intervention, 2,9 while others argue there is no difference in result. 5,10,11 Our study was carried out on near-term and term PROM patients because neonates of this gestation rarely suffer from prematurity-related complications; thus, the morbidity arising from rupture of membranes may be studied more easily. It is clear from our results that, as the duration from rupture of membranes to delivery increases, so does the risk of neonatal sepsis.…”

“…Some obstetricians recommend immediate intervention, 2,9 while others argue there is no difference in result. 5,10,11…”

Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

“…Mode of birth was reported in seven studies, although Yasmin et al (2013) only reported on caesarean births, and Poornima and Dharma Reddy (2011) claimed results but did not provide figures. Vaginal birth was more frequent for women with induced labour versus expectant management in four studies (Ayaz et al, 2008;Hannah et al, 1996;Rawat et al, 2018;Sadeh-Mestechkin et al, 2016), and more frequent for women with expectant management in three studies (Agnes & Lavanya, 2018;Ashwal et al, 2016;Shah & Doshi, 2012). Instrumental births were reported by four studies and also showed conflicting results with no significant p values (Agnes & Lavanya, 2018;Poornima & Dharma Reddy, 2011;Rawat et al, 2018;Sadeh-Mestechkin et al, 2016).…”

“…Vaginal birth was more frequent for women with induced labour versus expectant management in four studies (Ayaz et al, 2008;Hannah et al, 1996;Rawat et al, 2018;Sadeh-Mestechkin et al, 2016), and more frequent for women with expectant management in three studies (Agnes & Lavanya, 2018;Ashwal et al, 2016;Shah & Doshi, 2012). Instrumental births were reported by four studies and also showed conflicting results with no significant p values (Agnes & Lavanya, 2018;Poornima & Dharma Reddy, 2011;Rawat et al, 2018;Sadeh-Mestechkin et al, 2016). Similarly, caesarean births were also reported with enough variation in results that no conclusion could be drawn.…”

“…Duration from ROM to birth was reported by nine publications, though one gave durations only in a distribution table (Rawat et al, 2018), making comparison difficult. The remaining eight studies all reported duration from ROM to birth or full dilation to be reduced using active management of labour, with seven providing significant p values (Agnes & Lavanya, 2018;Ashwal et al, 2016;Ayaz et al, 2008;Hannah et al, 1996;Larrañaga-Azcárate et al, 2008;Poornima & Dharma Reddy, 2011;Sadeh-Mestechkin et al, 2016;Shah & Doshi, 2012).…”