Spontaneous Pre-Labour Rupture of Membranes at Term: Immediate versus Delayed Induction of Labour (original) (raw)
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International Journal of Womens Health and Reproduction Sciences
2015
Objectives: Rupture of membranes prior to the onset of labor is known as Premature Rupture of Membranes ( PROM). Early and correct diagnosis is crucial in order to prevent fetal and maternal risks that can be life threatening. We aimed to investigate the diagnostic ability of the tests in PROM. Materials and Methods: Nitrazine test, fern test, amnio-dye test, biochemical tests (insulin-like growth factor binding protein-1 and placental alpha microglobulin-1) were evaluated in terms of effectiveness in diagnosis of PROM. Results: A gold standard method has not yet been defined in PROM. Diagnostic tests (nitrazine test, fern test, Insulin-like Growth Factor Binding Protein-1 IGFBP-1 and Placental Alpha Microglobulin-1 PAMG-1) should be used when the diagnosis is not certain following history, examination with sterile speculum and ultrasonography evaluation. Conclusion: IGFBP-1 and PAMG-1 are tests based on bedside immunochromatographic method. Especially, PAMG-1 comes into prominence ...
Bangladesh Journal of Obstetrics & Gynaecology
not available Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 74-76
Background: Misoprostol, a prostaglandin E 1 analogue compared to prostaglandin E 2, has the advantage of being inexpensive and stable at room temperature, with its proven efficacy and safety. However studies on the effect of pH on the efficacy of misoprostol have yielded conflicting results. Thus its use in the induction of labour in patients with premature rupture of membrane requires further investigation. Objective: To evaluate the safety and efficacy of misoprostol in induction of labour in Nigerian women with prelabour rupture of membrane after 34 weeks of gestation. Materials and Methods: Three hundred and forty six Nigerian women with prelabour rupture of membrane who consented to participate in the trial were randomised into two arms of misoprostol and oxytocin. Labour was managed with WHO partograph. The primary outcome was the caesarean section rate and induction vaginal delivery interval. Results: The mean induction to vaginal delivery interval was significantly shorter in the misoprostol arm (504 mins) compared to 627 mins in the oxytocin arm (t=3.97; p=0.005). The caesarean section rate of 18.1% among the misoprostol arm was also significantly lower than the 41.4% recorded in the oxytocin arm (p=0.002). Among patients with Bishop score greater than 6 there were no statistically significant differences between the two groups in the outcomes measured. Conclusion: Misoprostol is not only effective but also safe when compared with titrated oxytocin in Nigerian parturients with prelabour rupture of membrane after 34 weeks.
Prelabour rupture of the membranes at or near term. Clinical and epidemiological studies
1998
Objectives: To study: (1) the risks and benefits for women with prelabour rupture of the membranes (PROM) after 34 weeks of gestation managed with different expectant periods from 24 to 72 hours; (2) perinatal infectious morbidity in the different groups and the association between demographic, intrapartum and postpartum variables and neonatal sepsis; (3) the influence of bath on infectious morbidity in mothers and neonates in women with PROM; (4) the false negative rate using a sterile speculum examination for the diagnosis of rupture of the membranes (ROM) compared to Diamine oxidase (DAO); (5) possible risks for the mother and the baby when the women were allowed to return home without further controls if amniotic fluid was not visible at the speculum examination; (6) the prevalence and risk factors for PROM in an urban Swedish population. Material and methods: Studies I-III were based on a randomised study comparing two different regimens in women with PROM. Women without contractions within two hours (n=1012) were randomised to induction the following morning after PROM (early induction group) or induction two days later (late induction group). Digital examination of the cervix was avoided until onset of active labour. Labour was induced with oxytocin if no spontaneous contractions occurred or if chorioamnionitis or fetal distress was detected. Study IV was based on women admitted for suspected rupture of the membranes after 34 weeks of gestation in which no amniotic fluid was visible at the sterile speculum examination. A test for DAO was performed. No further controls were performed if amniotic fluid was not visible at the speculum examination. Neonatal and obstetric outcome was recorded prospectively. Study V was based on a sample of 2880 women randomly selected from the national population register. They had delivered 2270 times at hospitals in the Göteborg area and 2242 of these case records were found. The case records were systematically analysed for the occurrence of PROM and potential risk factors for PROM. Two thousand two hundred and eight of these deliveries occurred after 34 weeks of gestation. The analyses were based on these 2208 deliveries. Results: There were no differences in the frequency of neonatal or maternal infections if the mother were randomised to early or late induction. No differences were found in the frequency of caesarean sections between the randomised groups. In nulliparous women ventouse extraction was more often used in the early induction group compared to the late induction group, 14% and 7% respectively (p<0.05). There was no difference in the incidence of neonatal infections between the groups. Clinical neonatal sepsis was associated with time from PROM to delivery over 32 hours, caesarean section, parous women and gestational age between 34 and 36 weeks. The false negative rate of a speculum examination of the diagnosis of rupture of the membranes in women without amniotic fluid visible at a speculum examination was 12%. This study did not show any disadvantages for mothers and infants if the women were sent home after a false negative speculum examination. The prevalence of PROM after 34 weeks of gestation in an urban Swedish population was 12.9%. In the multiple stepwise regression analysis risk factors for PROM were age at delivery ≥35 years, primiparity, premature contractions, PROM in a previous pregnancy and bleeding in the first trimester.
Journal of Medical Sciences, 2019
Objective: To study the efficacy, safety and maternal satisfaction of oral misoprostol for medical induction of labor inpatients with prelabour rupture of membrane at term (PROM).Material and Methods: This descriptive study was carried out in the Obstetrics unit of Rehman Medical Institute, Peshawar-Pakistan, from January 2015 to December 2018. A total of 546 admitted patients were selected for the studyin whom 50 microgram Misoprostol was administered orally at four hourly intervals. Labour was induced in selectedpatients and post-delivery complications were recorded.Results: The age range of patients was 25.19 years.±3.529 SD, Out of 546 gravid patients, Primigravida and multigravidawere 241 (44.1%) & 39(12.7%) respectively. There were more failed inductions in primigravida 71 (29.5%)patients, as compared to multigravida 39(12.7%). 436(79.8%) of women had a successful vaginal delivery comparedto 110(20.1%) patients who failed IOL and underwent emergency caesarean section. The indu...
INDUCTION OF LABOUR VERSUS EXPECTANT MANAGEMENT FOR PREMATURE RUPTURE OF MEMBRANES AT TERM
Background: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 wks of the gestations and before the onset of the regular painful uterine contractions .It occurs in ten percent of cases .These cases are either managed conservatively or by immediate induction of labour. Objective: To find out the efficacy and safety of induction of labour versus expectant management in women with premature rupture of membranes beyond 36 weeks gestation, in terms of induction delivery interval, operative interventions, and fetal outcome Material and Methods: A prospective, randomized controlled study was carried out for a period of two years from November 2008 to October 2010 at Rural Medical College, Loni. One hundred pregnant women with term PROM were assigned randomly, each in induction and expectant group. Results: .The mean interval from induction to delivery was significantly shorter in the induction group as compared with expectant group. Incidence of maternal morbidity was comparable in both the groups Neonatal morbidity was higher in expectant group. Incidences of hyper stimulation were more with induction group as compared to expectant group .There was no maternal or perinatal mortality in any group. Intrapartum complications and mode of delivery were similar in both groups. Conclusion: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval but increased rate of operative intervention. Maternal morbidity was comparable with induction and expectant line of management. However, neonatal morbidity was higher in expectant group.
To determine the factors associated with failed induction of labour in post-term pregnancies attending a tertiary care hospital in Karachi, Pakistan. Mehtods: This cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Unit II, Civil Hospital, Karachi. During January to July, 2016. Women with a gestational age of 40 weeks + 6 days to 41weeks + 0 days were included in the study. Obstetric history, maternal age, BMI, gestational age, Bishop score, induction to delivery interval and mode of delivery were noted. Failed induction of labour was considered when patients delivered abdominally. Descriptive statistics were calculated and chi-square test was applied post stratification where p-value < 0.05 was considered statistically significant. Results: 140 women met the inclusion criteria. The mean age of study subjects was 32.1 ± 2.9 years. Induction of labour failed in 78.6% of patients. Prolonged latent phase of labour was observed in 27.9% and a prolonged 2 nd stage of labour obsereved in 17.1%. A Bishop score > 5 was in 81.4%. BMI > 24.9 was in 47.1%. Spontaneous rupture of membrane (SROM) was in 27.1%. Conclusion: Induction of labour failed in 78.6% of post-term pregnancies in our study. A prolonged latent phase of the first stage of labour showed a significant association with failed induction of labour.
Background and objectives: Pre-labour Rupture of Membranes (PROM) is an enigmatic condition associated with high risk of maternal and Perinatal Morbidity and Mortality. The function of the amniotic fluid is mainly protective. It assists in maintaining an even temperature, acts as a buffer against external injuries checks the ascending infections, and during labour, acts as a dilating wedge in the cervix, so long as the amnion remainsintact. This occurs in 5-20% of all labours. The membranes may rupture either at term (> 37 weeks) when it is called term PROM or before 37 weeks of gestation when it is referred to as preterm PROM (PPROM). PROM is one of the most common clinical problem where a normal pregnancy can turn into a high risk situation. A careful consideration of various factors and individualization of cases is necessary for appropriate management. Materials and Methods: A prospective study of maternal and perinatal outcome in pre-labour rupture of membranes in term gestation(≥37 weeks). This Study was done at Government maternity hospital, Hanamkonda, Warangal ,from June-2019 to September-2020.Total number of deliveries during this period was-7564.The total number of cases with pre-labour rupture of membranes (PROM) at term gestation were-212 and the INCIDENCE of pre labour rupture of membranes (PROM) at term gestation was2.8%. Results: Maximum women were in the age group of 20-29 years 89.6%. The mean age was 23.6 years with standard deviation of 3.3 years. In present study 62.3%(132 cases) were unbooked,37.7%(80 cases) were booked. For perinatal morbidity the chi square statistic is 19.1123 and the p-value is 0.000012 which is statistically significant at (p<0.05). 61.3%in the study were primi gravida. 38.7% in the study was multigravida. 74.1%(157-cases) belonged to low socio economic status. 25.9% (55-cases) belonged to middle socio economic status. Among primigravida 8.5% (11-cases) had bishop score of 0-2 and 62.3%(81-cases) had bishop score 3-4,and 29.2%(38 cases) had a score of 5-6. Maximum women delivered between 12-24 hours of PROM in both primi & multi. 73.8% of primigravida cases delivered between12-24 hours of PROM, 74.4% of multigravida cases delivered between 12-24 hours of PROM. 56.6% of women had vaginal delivery. Instrumental delivery was noticed in 2.8% Rate of cesarean section was 40.6%.. 58.97% of maternal morbidity occurred with PROM to delivery interval of greater than 24 hours.61.11% of Fetal morbidity with PROM to delivery interval greater than 24 hours duration.60% of Perinatal mortality was with PROM to delivery interval of >48 hours. Interpretation and Conclusion: PROM is an enigmatic condition associated with high risk ofmaternal morbidity, perinatal morbidity and mortality. It complicates 5-10% of all pregnancies. Complications increasewith decrease in gestational age and increase in the latentperiod. Women should be educated about the possibility of PROM and the needto report at the earliest. And they should be educated about complications of prolongedPROM. Thus a team approach, early recognition of premature rupture of membranes and their associated complication and appropriate. Management of situation helps in reducing the problems caused by PROM to a greatextent.
Bangladesh Journal of Obstetrics & Gynaecology, 2020
not available Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 167-170
International Journal of Basic and Clinical Pharmacology, 2016
Premature rupture of membranes (PROM) is defined as rupture of membranes before onset of labor and complicates 5-10 % of pregnancies. At least 80% of cases of PROM occur at term. In spite of many studies available in the literature, the clinical management is surprisingly controversial. 1 Approximately 60-70% of term PROM cases are followed by the onset of labor within 24 h and an additional 20-30% will start within 72 hours. 2,3 Diagnosis and proper management is very important as it is implicated for various fetal and maternal complications generally due to infection. There is a controversy as to whether patients should be kept on conservative management or induction should be carried out. The ACOG guidelines define "the waiting time as an adequate ABSTRACT Background: Premature rupture of membranes (PROM) complicates 5-10 % of pregnancies. Approximately 60-70 % of term PROM cases are followed by the onset of labor within 24 hours. Diagnosis and proper management is very important. In spite of many studies available in the literature, the clinical management is surprisingly controversial. Methods: Study conducted was prospective randomised controlled trial. Total 150 women were selected fulfilling the inclusion criteria, randomly allotted to the 3 groups. In group A, patients were observed for 24 hours. If labor didn't supervene in 24 hours since admission, induction of labor was done depending on the bishop's score. In the group B, labour was induced by vaginal misoprostol 25 micrograms given 4 hourly for 4 doses and in group C, labor was induced by instillation of 0.5mg PGE2 gel in the posterior fornix. The women were observed for onset and progress of labour. Failure of induction was considered if patient was not in established labour within 24 hours of instillation of first dose of cerviprime/misoprostol. Labour was monitored and managed as per hospital protocol. The analysis verified the following variables: duration of latent phase and active phase of labour, mode of delivery (spontaneous/vaccum/forceps/LSCS), third stage complications (PPH/fever/retained placenta), neonatal outcome. Results: Thirty percent women had onset of spontaneous labor during expectant management in group A. The durations of latent phase and active phase of labour were lower in group B and C than group A (9 and 10.4 versus 15 hours; p<0.001) and (4 and 6 versus10 hours; p<0.001), respectively. Immediate induction in group B and C resulted in significantly lower rate of caesarean section (17% and 19% versus 28.5%, P= 0.049) and operative vaginal delivery (5% and 3% versus 13%, P=0.007). Only a few maternal-neonatal infections occurred and no significant difference was noted (2.7% and 3% versus 3.5%, P= 0.71). Conclusions: Immediate induction with prostaglandin shortens the delivery interval and lowers the caesarean section rate as compared to expectant management; however the neonatal outcome is similar in the three groups.