Maternal and Fetal Outcome of Prelabor Rupture of Membranes at Term. Prom) - a trial of 24 hours of expectant management

Objective: To find out the maternal and fetal outcome of 24 hours of expectant management. Design: Prospective descriptive study. Settings: Labor room of obstetrics and gynae unit I, services hospital Lahore. ubjects: Participants \\ ere 100 women presenting with prelabor rupture of membranes at term, 50 nullipara and 50 multipara with cephalic presentation and no contraindication to vaginal delivery. Methods: All the participants of the study group were subjected to conservative management for 24 hours under antibiotic cover of inj cefataxime followed by induction if labor did not start spontaneously in 24 hours or if signs of chorioamnionitis developed at any stage. Data was collected on a Performa, which was then entered on database IVan analyzed in percentages on spss statistical package. Results: The magnitude of PROM in gynac unit 1 services hospital ill the year 2002 was 7.008%. 84% patients went into spontaneous labor, 2% patients developed signs of chorioamniornt . and 14% patient did not enter into spontaneous labor after 24 hours of PROM. 94% patients with PROM delivered vag lly total of 6 cis were carried out, 2% cis due to fetal distress, 2 0/0 for failed induction and 2% for fetal distress after indu on. Postnatal complications included chorioanmionitis 2%, PPH -00. puerperal pyrexia ~%, wound infection 3%. and D\ 'T ill 1% patients. Neonatal complications included admission to ICe in 8% babies and neonatal infection in 1%. There - no fetal mortality. Conclusion: Conservative approach did no negatively affect fetal . maternal outcomes. f\..eywords:


Objective:
To find out the maternal and fetal outcome of 24 hours of expectant management.Design: Prospective descriptive study.Settings: Labor room of obstetrics and gynae unit I, services hospital Lahore.ubjects: Participants \\ ere 100 women presenting with prelabor rupture of membranes at term, 50 nullipara and 50 multipara with cephalic presentation and no contraindication to vaginal delivery.Methods: All the participants of the study group were subjected to conservative management for 24 hours under antibiotic cover of inj cefataxime followed by induction if labor did not start spontaneously in 24 hours or if signs of chorioamnionitis developed at any stage.Data was collected on a Performa, which was then entered on database IVan analyzed in percentages on spss statistical package.Results: The magnitude of PROM in gynac unit 1 services hospital ill the year 2002 was 7.008%.84% patients went into spontaneous labor, 2% patients developed signs of chorioamniornt .and 14% patient did not enter into spontaneous labor after 24 hours of PROM.94% patients with PROM delivered vag lly total of 6 cis were carried out, 2% cis due to fetal distress, 2 0 /0 for failed induction and 2% for fetal distress after indu on.Digital examination was avoided and PROM was confirmed by sterile speculum examination to see the pooling of amniotic fluid in posterior fornix of vagina or repeated pad checks.Complete blood and urine examinations were sent as baseline.Vaginal swabs were ent for culrure and sensitivity and antibiotic cover was given with injection cefatexime Igram LV. at 12 hourly intervals.Patients were monitored for their pulse, temperature, color and odor of liquor on pad and uterine tenderness.
If labor did not start spontaneously in 24 hours or if there was any sign of chorioamnionitis, induction was done after Bishop scoring.If Bishop score was 5 or <5, ripening and induction was _one by insertion of prostaglandin Ez pessary in the posterior fomix of vagina.If Bishop score was greater than 5, induction was done with oxytocin infusion.
Poor fetal outcome was determined by low Apgar score at 5min, sign of asphyxia, prolonged tachypnoea, tachycardia and admission to neonatal intensive care unit for sepsis, hyperpyrexia or hypothermia.PRO\t1 i.e. ruprure of memb nor to the onset of labor at or beyond 37 weeks ges.ation' omplicates about 10% of all gestations.' Natura: se of PROM is labor and 80% of cases go into -labor within 24 hours of PROM 3 .Its manage -ei er expectant or active.Which of these two -~management has remained a highly controvers I case of expectant manauement there i mere: ~infection to the morl.erand baby \\ hen la ed for more than 24 hours.On the other hand.
creased risk of failed induction and operauv e when induction is attempted too soon a r P -0 in this study a tailor 1112deapvroach of the management for 24 hours was adopted followed non if labor did not start spontaneously or if 10: noarnnionitis developed at any stage.
Purpose of stud_ to analyze the maternal and feta 1 outcome of 2.l ur expectant management in patient, of PROM at term and to find out that this regimen does decrease maternal morbidity without increasing the chances of fetal morbidir-and mortality.
Subjects and methods I: was a prospective de criptive study.261 women were admitted with PRO. 1 at term, Out of these, 100 women who fulfilled the criteria of study were selected.ullipara and multipara were equal in number (50% each).All the patients of study group were subjected to conservative manageruen: for 2~hours after counseling and Informed consent.Two babies with forceps deliverie were admitted to leu.
Their indications of admission were meconium aspiration (1), and hyperthermia (I).Three patients delivered by SVD were admitted to ICU.They had low Apgar score (I), transient bradicardia (1), while one of the babies was delivered •• vith apnea and had to be incubated.
Mean apgar score at one minute 5.9 Mean apgar score at 5 minutes 8.7 Admission to ICU 8 Neonatal infection I Fetal mortality 0 The results of culture sensitivity reports of HVS showed 95% patients to be culture negative (95%) while only 5% patients were culture positive.2%patients had growth of staphylococcus aureus, 1%E.Coli, I% pseudomonas, 1% klebsiella and they later developed signs of chorioamnionitis for which they were induced.
Blood cultures of all the babies were sent admitted to ICU with PROM.Of the 8 babies, only I baby had growth of staff aureus.

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Discussion PROM results in increased pregnancy complications especially in Teased risk of infection and mechanics difficultie in delivery, cord compression and fetal distress.In this study fetomaternal outcome of 24, hours of conservative management was studied and compared with national and ill emational studies.The magnitude of PROM at term wa -.008% which is higher than a local study by Dr.. 'a Ira -.3%) but lower than international studies by Dr. Rathmer (10.0%) and Dr. Ladfors (12.9%).Ratio between boo red and unbooked patients showed that 2 % of patients were booked cases.The attendance of women at antenatal clinic allows us to provide information about PRO 1 to the patients as a component of routine antenatal care.Accurate dating of gestation can also be done by early ultrasound scanning if number of booked cases in antenatal clinics is improved, In this study, 84% of Isubjects with PROM at term entered into spontaneous labor within 24 hours.In study by Dr H Cammu, 23% patients did not have spontaneous labor after 24 hours.This number is much larger than our series in which only 16% of the patients had not spontaneous onset of labor.This difference may be due to difference in parity between both groups as more multipara go into spontaneous labor after PROM as compared to ANNALS VOL.I3 Postnatal complications included chorioanmionitis 2%, PPH -00.puerperal pyrexia ~%, wound infection 3%.and D\ 'T ill 1% patients.Neonatal complications included admission to ICe in 8% babies and neonatal infection in 1%.There -no fetal mortality.Conclusion: Conservative approach did no negatively affect fetal .
Maternal and fetal Outcome of Pre labor Rupture of Membranes at Term.Prom nulhpara.(Instudy by H Carnmu. only nullipara were taken into account).Mean Bishop Score in our study group was -1.93 as compared to 2.6 in actively managed group of :'-.aslraTasneern.High bishop score in our study is in 0.1 JAN -MAR 2007 99 --