PROM has major impact on maternal and fetal outcome, complicating the pregnancy with significant morbidity is associated, before, during and after labor. Patients with PROM should be delivered, to avoid infection to both mother and fetus but early interference may increase the incidence of caesarean section. Early and accurate Management of PROM can prevent the risk of fetal and maternal complications.
Objectives: To assess the difference in mean Bishop score and proportion of failed induction, fetal distress, maternal-fetal outcome after oxytocin infusion at 8 hours of PROM in both groups (immediate induction v/s expectant management).
Methodology: This study was Randomized controlled trial (RCT) done on patients having complain of leaking P/V, admitted in Department of Obstetrics and Gynaecology, Zenana Hospital, SMS Medical College, Jaipur over a period of one year (2012-2013). A total of 304 cases (152 in each category) were studied. Patients were divided into two groups, in first group all patients were managed by Immediate induction (Dinoprostone gel) while in second group by Expectant management.
Results: Mean gestational age was 39.45±0.75 wks. Mean duration of leaking was 4.33 hrs. 89.47% (136) patients delivered vaginally and 10.59% (16) underwent LSCS in expectant management as compared to 54.60% (83) pts. delivered vaginally and 45.39% (69) underwent LSCS in Immediate induction. In Present study 93.15% went into spontaneous labor within 1-10 hrs. in expectant management. In our study, most common indication for LSCS was fetal distress accounting for 54.11% (46) in immediate induction and 14.11% (12) in expectant management. Maternal complication rate in 8-16 hrs duration of PROM was 11.38%, while in 17-28 hrs duration, it was 43.47%. Neonatal complication rate in 8-16 hrs of PROM was 6.76% while 60.86% in 17-28 hrs of PROM.
Conclusion: An expectant management followed by delayed induction with oxytocin will allow a good number of women go into labor without an increase in CS rate. Infectious morbidity for mother and fetus are low in expectant management. Therefore expectant management is better than immediate induction in term PROM patients