Rizwana Chaudhri, Kaukab Naheed.
A comparison of active and expectant management of Pre-Labour spontaneous Rupture of Membranes (PROM) at and near term.
Pak Armed Forces Med J Jan ;52(1):38-46.

This study compared maternal and perinatal outcome of active management of PROM at and near term with expectant management for 24 hours followed by late induction if needed. 157 women at 36-41 week gestation, having single alive cephalic fetuses and uncomplicated PROM were randomly assigned to either active or expectant management. Actively managed women were induced either with prostaglandin E2 vaginal pessary or with oxytocin infusion depending on Bishop`s scores, within 8 hours of PROM. Expectantly managed women were watched for spontaneous onset of labour with maternal and fetal monitoring. They were induced after 24 hours if not in labour. The two groups were compared with respect to mode of delivery, labour characteristics, and neonatal and maternal infectious morbidity. Complete results were obtained for 75 women in each group. 61.3% women went into spontaneous labour within 24 hours, 29% were induced after 24 hours and active intervention for fetal distress or amnionitis was done in 9.7% cases in expectant management group. Actively managed nulliparae had a lower LSCS rate but without statistical significance i.e. (11.1% Vs. 15.8% with p-value >0.05) and a statistically higher operative vaginal delivery rate (19.4% Vs. 10.5% p-value <. 05). There was no significant difference in the mode of delivery among multiparae (7.7% Vs. 8.1% LSCS rate and 7.7% Vs. 5.4% operative vaginal delivery rate). More LSCS were performed for labour dystocia and failure of induction in active management group while more were performed for fetal compromise in the expectant management group. They have shorter interval from induction to onset of labour (10.2 Vs. 15.4 hrs) and from rupture of membranes to delivery (16.2 Vs. 22.3hrs) while duration of active labour was comparable (6.45 Vs. 7 hrs). Their lesser number (57.6%Vs 76%) required augmentation with oxytocin. There was no significant difference in number of vaginal pessaries used in two groups. Clinical chorioamnionitis was high in the expectant management group (8% Vs. 12%p value >. 05) without statistical significance while post-partum fever rate was comparable (2.5%). The neonatal sepsis rate did not differ significantly between the two groups (4% Vs 5.3%) and no maternal or neonatal mortality was observed. In conclusion, was that there is no statistical difference in the maternal and fetal risk of infectious morbidity and cesarean section rate in the two groups.

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