Prelabour Rupture of the Membranes at Term and Unfavourable Cervix; a Randomized Placebo‐controlled Trial on Early Intervention with Intravaginal Prostaglandin E2 Gel

Abstract

Fifty nine women with prelabour rupture of membranes, unfavourable cervix and no evidence of infection or fetal distress were randomized formally to receive prostaglandin E2 (3mg) gel or sterile K-Y Jelly intravaginally. Conservative expectant management was followed for the next 24 hours. The subsequent management of the labour followed departmental protocol. The women who received prostaglandin went into labour sooner and were delivered earlier but the duration of labour was not significantly different. There were no significant differences in other clinical outcomes. There was 1 case of uterine rupture in the prostaglandin group. We conclude that early intervention with prostaglandin E2 gel intravaginally confers no advantage compared with conservative management except for earlier confinement in this group of patients.

Perinatal and Maternal Outcome in Prelabour Rupture of Membranes

“…Prostraglandin induction shortens the time to delivery and decreases the risk of infection and Cesarean section rate is not increased. 14,15 After taking into consideration fetal presentation, parity, gestational age, cervical favorability, presence of signs/risk factors for chorioamnionitis and by exclusion of fetal distress, Cephalopelvic Disproportion, labour is induced at the time of presentation. 16 Thirteen cases of Cesarean section in study group were done for fetal distress and failed induction and 10 cases of Cesarean section was done in control group.…”

Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)

“…This review now has a total of 23 included trials (Akyol 1999;Ayaz 2008;Beer 1999;Cheung 2006;Chung 1992;Fatima 2015;Javaid 2008;Krupa 2005;Mahmood 1992;Mahmood 1995;Maqbool 2014;McQueen 1992;Milasinovic 1998;Natale 1994;Ottervanger 1996;Selmer-Olsen 2007;Shah 2012;Shalev 1995;Sperling 1993;Tamsen 1990;Tasnim 2000;Wagner 1989) involving 8615 women and their babies (including the large Hannah 1996 trial of 5042 women). For further details see Characteristics of included studies.…”

“…China (Cheung 2006;Chung 1992), and two in Scotand (Mahmood 1992;Mahmood 1995); one trial was conducted across multiple countries (Canada, the UK, Australia, Israel, Sweden and Denmark) ; the remaining trials were conducted in Brazil (Krupa 2005), Canada (Natale 1994), Denmark (Sperling 1993), Germany (Beer 1999), India (Shah 2012), Norway (Selmer-Olsen 2007), Serbia (Milasinovic 1998), Sweden (Tamsen 1990), the Netherlands (Ottervanger 1996), Turkey (Akyol 1999), USA (Wagner 1989), and Zimbabwe (McQueen 1992).…”

Induction of Labor in Patients with Term Premature Rupture of Membranes

“…In comparison to oxytocin and or expectant management, these studies demonstrated that induction of labor in PROM at term patients with prostaglandin E 2 was accompanied by a higher rate of vaginal delivery and less infectious morbidity. In contrast, other investigators found that although prostaglandin E 2 is a safe and convenient method for induction of labor in PROM at term, oxytocin was preferable in terms of cost and effectiveness [18][19][20][21].…”