DefinePK

Abstract

Background: Preterm Premature Rupture of Membranes (PPROM) between 34+0 and 36+6 weeks of gestation presents a significant clinical challenge, as the choice between Immediate Induction of Labor (IoL) and Expectant Management (EM) may impact both maternal and neonatal outcomes. While IoL may reduce the risk of infection, EM allows for spontaneous labor, potentially lowering cesarean rates. However, variations in practice and outcomes necessitate high-quality evidence to guide optimal clinical decision-making.
Objective: To compare maternal and neonatal outcomes between Immediate Induction of Labor and Expectant Management in women with PPROM at 34+0 to 36+6 weeks’ gestation.
Methods: This randomized controlled trial enrolled 313 pregnant women diagnosed with PPROM between 34+0 and 36+6 weeks. Participants were randomly assigned to the IoL group (n=157) or the EM group (n=156). In the IoL group, labor was induced promptly using oxytocin or misoprostol. In the EM group, patients were managed expectantly with regular monitoring until spontaneous labor onset or clinical indication for induction. Primary outcomes included mode of delivery, NICU admissions, and maternal complications. Secondary outcomes assessed were Apgar scores, birth weight, postpartum hemorrhage, postpartum infection, and hospital stay. Statistical analyses included Chi-square and t-tests, with p<0.05 considered significant.
Results: The IoL group had a higher cesarean rate (40%) than the EM group (25%) but lower NICU admission rates (25% vs. 45%). Birth weight was higher in EM (3064.90g) versus IoL (2790.10g), while average Apgar scores were slightly higher in IoL (8.00 vs. 7.95). Postpartum hemorrhage occurred in 10% of IoL and 15% of EM patients. Average hospital stay was shorter in the IoL group (3.80 vs. 4.60 days).
Conclusion: Immediate Induction of Labor in late preterm PPROM may improve short-term neonatal outcomes and reduce maternal infection rates but is associated with a higher risk of cesarean delivery.