A Comparative study on Immediate Versus Delayed Induction in term Premature Rupture of Membranes A comparative study on immediate Versus delayed induction in term Premature rupture of membranes

INTRODUCTION: Foetal membrane or the chorioamniotic membrane refers to the chorion and amnion which surround and protect the foetus during pregnancy. Normal progress and outcome of pregnancy depends in part on the normal development & structural integrity of the Foetal membrane. One of its major functions is to maintain the protective intrauterine fluid environment upon which the foetus depends for its survival in utero. In most pregnancies labour begins at term, in the presence of intact Foetal membranes. Without interventions their spontaneous rupture usually occurs near the end of the first stage of labour. Premature rupture of membranes (PROM) is defined as the spontaneous rupture of amniotic membrane with a release of amniotic fluid before the onset of labour. If the membranes rupture after 37 weeks of gestation it is called term Premature Rupture of Membranes. If the rupture of membranes (ROM) occur before 37 weeks of gestation is termed as the preterm premature rupture of membrane (PPROM). Premature rupture of membrane has an incidence of about 10% of all pregnancies and is a significant event as it can cause maternal complications, increased operative procedures, neonatal morbidity and mortality. AIM OF THE STUDY: To compare the maternal and neonatal outcome between immediate and delayed induction with PGE2 gel in women with term premature rupture of membranes. MATERIALS AND METHODS: This was a Comparative Study involving women admitted to the Institute of Obstetrics and Gynaecology with rupture of membranes prior to onset of labour (gestational age more than 37weeks up to 41 weeks & meeting other strict inclusion criteria as described below) and the neonates born to these women. Study Period: One year (2011-2012). Study Location: Institute of Obstetrics and Gynaecology, Egmore, Chennai-8. Method of Data Collection: Inclusion Criteria: Women with; 1. Term premature rupture of membranes < 12 hours duration at the time of admission. 2. No evidence of foetal distress. 3. No evidence of sepsis (maternal tachycardia, pyrexia, uterine tenderness). 4. No other risk factors in pregnancy e.g. medical complications, malpresentation, abnormal lie, multiple pregnancy and previous caesarean section. 5. Modified Bishops score < 6. 6. All neonates born to women included in the study. Exclusion Criteria: 1. Premature rupture of membranes for > 12 hours at the time of admission. 2. Gestational age 41 weeks. 3. Evidence of foetal distress / sepsis. 4. Medical complications, malpresentation, abnormal lie, multiple pregnancy and previous caesarean section. 5. Suspected CPD. 6. Women in active labour. 7. Patients who are HIV positive or immune compromised. SUMMARY AND CONCLUSION: Immediate induction was compared with that of delayed induction after 12 hours of PROM in term PROM cases. • Both study groups were comparable with regard to age, parity, booking status and gestational age. • During the waiting period of 12 hours 38% of cases entered active labour in the delayed induction group. So significantly lesser number of patients in the delayed induction group required induction compared to early induction group. • Significantly higher doses of PGE2 were required in the early induction group. • The PROM delivery interval was significantly shorter in the early induction group. • LSCS and operative vaginal deliveries were more in the early induction group. • Failed induction and labour abnormalities were more in the early induction group (statistically significant), while foetal distress was slightly higher in the delayed induction group. • There was no significant difference in chorioamnionitis in both the groups. Leukocytosis was more specific marker compared to fever and maternal tachycardia. • There was no difference in maternal and neonatal infectious morbidity between the two groups. This may be due to the use of prophylactic antibiotics. • Neonatal outcome was equally good in both the groups. • Though the mean hospital stay was not different, more number of patients in group A had a stay of >5 days due to increased number of LSCS