Outcomes of Induction of Labor versus Expectant Management in Women with Premature Rupture of Membrane

Abstract

Objective: To assess outcomes of induction of labor versus expectant management in pregnant women suffering from preterm rupture of membrane. Study Design: Randomized controlled trial. Place and duration: It was held in Gynecology Department Bahawal Victoria Hospital, Bahwalpur  from 12 December 2017 to 25 May 2018. Methodology: 80 women were enrolled in this clinical trial and they were categorized into two groups IOL and EM randomly. Women with single or twice pregnancy having PROM at > 37 weeks gestation, they were eligible for this study. PROM was clinically examined and confirmed with Ferning and positive litmus tests. Digital vaginal examination was avoided. Women with abnormal cardiotocogram, major fetal anomalies, severe preeclampsia, sign of intrauterine infection, monochorionic multiple pregnancies, meconium stained amniotic fluid and HELLP syndrome was excluded from this clinical study. All the pregnant women who met these criteria of this study were randomly assigned to EM group and IOL group with lottery method.Computer software SPSS version 23 was used for entering and analyzing data. Frequencies and percentage was calculated for maternal and neonatal variables like mode of delivery, Chorioamnionitis, maternal and neonatal sepsis, Pneumonia, HELLP syndrome, Apgar score, Meningitis, Convulsion, Neonatal temperature, Neonatal ICU admission and RDS. Standard deviation and mean were used to describe the maternal length of hospital stay (days), Neonatal birth weight (g) and neonatal length of ICU stay (days). Student t test and Chi square test were used to find frequency, percentage, SD and mean respectively. P value < 0.05 was considered to be significant.Result: Rates of neonatal and maternal infection were insignificant in both study groups. The neonatal infection rate was 7.5 % for both IOL and EM group, while maternal infection rate was 7.5 % in IOL group, 10 percent for the EM group, and 2.7 % in the EM (prostaglandin) group. The rates of C-section were insignificant. Rates of clinical chorioamnionitis were significant in both study groups. Clinical chorioamnionitis was less likely to be developed in the women of the IOL group than in women of EM group (7.5 % vs. 12.5 %, P_0.04), as was pneumonia (zero vs. 10 %, P-0.040). Length of hospital stay was significant in IOL and EM group (7.57±1.15 vs. 6.85±1.13, P- 0.004), as neonatal ICU admission was (12.5 % vs. 7.5 %, P- 0.04). Similarly, meningitis was (zero vs. 5 % and P- 0.030), as was convulsion (zero in IOL vs. 1.5 % in EM, P- 0.040).Conclusion: It has been concluded that management of induction of labor (IOL) is very suitable for all pregnant women suffering from preterm rupture of membrane (PROM) than expectant management (EM) because it decreases maternal as well as fetal complications.

Keywords: Expectant management (EM), Induction of labor (IOL), premature rupture of membrane (PROM).