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Title: Comparison of Maternal and Neonatal Outcome of Induction of Labour with Expectant Management in Patients with term Prelabour Rupture of Membranes
Authors: Zaib Malik, Shakra Tabassum, Sadia Zainab, Anum Manzoor
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: Supplementary 1
Language: English
DOI: 10.51253/pafmj.v73iSUPPL-1.4354
Keywords: Expectant managementInductionPrelabour rupture of membrane
Objective: To compare the maternal and neonatal outcomes of induction of labour with expectant management in patients with term prelabour rupture of membranes.
Study Design: Quasi-experimental study.
Place and Duration of Study: Labour ward of department of Gynecology and Obstetrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from May to Nov 2017.
Methodology: A total of 1800 women with term (gestational weeks ≥37 weeks assessed on Last menstrual period) premature rupture of membrane between 20-35 years were included. Patients with twin pregnancy, suspected or confirmed chorioamnionitis and scarred uterus were excluded. Patients were randomly allocated either to active (Group-A) or expectant management group (Group-B) by table of random numbers. Mode of delivery, APGAR score, neonatal sepsis and development of chorioamnionitis was recorded for both the groups within first 24 hours after birth.
Results: In our study, mode of delivery in Induced Group was spontaneous vaginal delivery in 819(91.0%) and caesarean section in 81(9.0%) whereas mode of delivery in Expectant Group was spontaneous vaginal delivery and caesarean section in 776(86.22%) and 124(13.78%) respectively. Neonatal sepsis was 144(16.0%) in Expectant Group and 104(11.56%) in Induced Group. Chorioamnionitis was 161(17.89%) in expectant group and 92(10.22%) in Induced Group. APGAR <7 at 1 minute was 204(22.67%) in Expectant and 174(19.33%) in Induced Group. APGAR <7 at 5 minutes was 91(10.11%) in expectant and 71(7.89%) in induced group.
Conclusion: This study concluded that management outcome of induction of labor in term prelabor rupture of membranes is better than expectant management.
To compare the maternal and neonatal outcomes of induction of labour with expectant management in patients with term prelabour rupture of membranes.
Quasi-experimental study conducted in the labor ward of Pak Emirates Military Hospital, Rawalpindi, Pakistan, from May to November 2017. A total of 1800 women aged 20-35 years with term prelabour rupture of membranes (PROM) were included. Patients with twin pregnancy, suspected or confirmed chorioamnionitis, and scarred uterus were excluded. Participants were randomly allocated to either active induction (Group-A) or expectant management (Group-B). Outcomes recorded included mode of delivery, APGAR score, neonatal sepsis, and development of chorioamnionitis within 24 hours postpartum. Data was analyzed using SPSS version 21.0 with chi-square tests for comparisons.
graph TD
A["Recruit 1800 women with term PROM"] --> B["Random Allocation"];
B --> C["Group-A: Active Induction"];
B --> D["Group-B: Expectant Management"];
C --> E["Induce Labour"];
D --> F["Wait for Spontaneous Labour"];
E --> G["Record Outcomes"];
F --> G;
G --> H["Analyze Data SPSS, Chi-square"];
H --> I["Compare Maternal & Neonatal Outcomes"];
I --> J["Draw Conclusions"];
The study suggests that active management with induction of labor for term prelabour rupture of membranes leads to better maternal and neonatal outcomes, including a higher rate of spontaneous vaginal delivery and lower rates of caesarean sections, neonatal sepsis, and chorioamnionitis, compared to expectant management. This aligns with some existing literature, although variations in findings across studies are noted, potentially due to differences in sample size, study duration, and patient populations.
- Spontaneous vaginal delivery was higher in the induced group (91.0%) compared to the expectant group (86.22%).
- Caesarean section rates were lower in the induced group (9.0%) compared to the expectant group (13.78%).
- Neonatal sepsis was lower in the induced group (11.56%) compared to the expectant group (16.0%).
- Chorioamnionitis was lower in the induced group (10.22%) compared to the expectant group (17.89%).
- APGAR scores <7 at 1 minute were slightly lower in the induced group (19.33%) compared to the expectant group (22.67%).
- APGAR scores <7 at 5 minutes were slightly lower in the induced group (7.89%) compared to the expectant group (10.11%).
Management of term prelabour rupture of membranes with induction of labor appears to yield better maternal and fetal outcomes than expectant management.
- Sample size: 1800 women were included in the study.
- Study duration: The study was conducted from May to November 2017.
- Caesarean section rate in induced group: 9.0% of women in the induced group underwent caesarean section.
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