Role of prostaglandin in the management of prelabour rupture of the membranes at term

Abstract

Objective To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term. Design A prospective randomized study. Setting Labour Ward, Aberdeen Maternity Hospital. Subjects 230 primigravidae at term with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. Interventions In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses. Main outcome measures PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. Results There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31%vs 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section. Conclusion The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.

Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel

“…Individual trials have compared single-dose PGE2 vaginal gel administration to placebo 15-17 and multiple-dose protocols to placebo [18][19][20] . To date, however, there has been only one trial 10 comparing early amniotomy with repeat PGE2 administration.…”

On the management of premature rupture of membranes in term pregnancies

“…We d o not hope that Moldin et al build their argument for delaying induction of labor for 24 h or more in a Swedish population on these 5 women in a foreign population of women where we really have scanty background in- Scand 71 (1992) formation. As a matter of fact, to show a 50% difference in neonatal infection between delayed induction of labor, with a vaginal examination vs early induction of labor ( a = 0.05; p = 0.20; power = 0.80) about 2,000 + 2,000 patients would be needed (1). Awaiting this study it may be better to induce women with PROM at term.…”

Premature Rupture of Membranes- A Clinical Study

“…These cases were delivered by Lower segment Caesarean section (LSCS) soon after admission. Depending on the cervical score and favourability of cervix, labour was induced either with vaginal prostaglandin E2 gel 7 or oxytocin drip. Labour was monitored with partogram and cases of foetal distress/ failed induction were delivered by caesarean section.…”