Background: In term PROM, labour is likely to follow soon afterwards, but in preterm PROM, about 35-50% cases labour starts within 24 hours, 70% cases starts within 72 hours, about 90% delivery occurs usually within 7 days. Perinatal morbidity and mortality is increased while rupture occurs prior to term resulting in delivery of premature foetus. Approximately 80% of patients with PROM at term go into labour within 24 hours and 95% within 72 hours. The incidence of PROM, is variable, most studies report an incidence of 2-18% with an avg. Of 10%. In 70%of cases, it occurs in pregnancies at term (Williams 23rd edition.);
1) The active versus expectant management in women with Premature rupture of membranes at term pregnancy
2) The maternal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.
3) The neonatal outcome in active as well as expectant management in patients with premature rupture of membrane at term pregnancy.
Methods: 200 patients were selected after confirming foetal maturity and rupture of membrane by history and clinical examination. Foetal well-being was assessed by clinical examination and ultrasonography. Informed consent was taken from every patient included in this study.
Results: Duration of labour between both groups observed no significant variation. Selected patients with favourable Bishop’s score (>6) may be the cause of no incidence of undue delay or complications. In Group 1, 44% delivery occurred within 6 hours, 52% within >6-12 hours, 4% took more than 12 hours for delivery. In Group 2, 40% delivered within 6 hours, 56% in the span of >6-12 hours, 4% took more than 12 hours for delivery. In Expectant group (Group 2) duration of labour is significantly lower in multigravida whereas no such difference is seen in Active Management (Group 1) Group in relation to gravida.
Conclusions: In case of premature Rupture of Membranes at term –both expectant and active management leads to similar maternal and neonatal outcome. Since outcome of active and expectant management may not be very different5, women need to have appropriate monitoring and counselling to make informed choices.