Planned early birth versus expectant management for prelabour rupture of membranes at term

Abstract

Objective: To compare the feto-maternal outcome of planned early birth versus expectant management (waiting) among patients with prelabor rupture of membrane at term (37 weeks or more) at LUMHS.

Methodology: This randomized control trial was conducted at gynae and OBS department of Liqaut University of Medical and health Sciences from March 2015 to February 2016. Woman with uncomplicated PROM without signs of active labour, having single alive fetus with cephalic presentation and gestational age of 37 weeks to 42 weeks were included. Patients were equally divided in two groups as; Group-I (Planned early birth) patients received induction in form of prostaglandin E2 vaginal pessary maximum of two vaginal tablets were used 6 hours apart. Group-II (Expectant management) patients waited for spontaneous onset of labour with maternal and fetal monitoring if labour did not begin within 24/hour than induction started with oxytocin infusion or prostaglandin E2 vaginal passery to deliver the patient. Data was collected via study proforma and was analyzed by SPSS version 20.

Results: Total 06 women were incorporated and most of the patients were between age group of 18 to 34 years in both groups (group A and group B) as 83.3% AND 80.0% respectively. C-section was done in 1 patient of group A and 6 patients of group B. C-section+puerperal sepsis were noted in 3 patients of group A and one patient of group B. Chorioamnionitis was noted in one case of group A and one case of group B. Chorioamnionitis with c-section was found in 1 patient of group A and two patients of group B. Peripartum sepsis was in 3 patients of group A and one patient of group B. However no maternal mortality and ICU admission were seen all the patients were normally discharges. Feto-maternal outcome was statistically insignificant in both groups (p=>0.05).

Conclusion: Planned management (induction by prostaglandin E2 vaginal pessary) slightly decreases the risk of chorioamnionitis and caesarean section. Meanwhile both management options may not be very different and both methods can be successfully employed for the management of term PROM.