Induced Labour in Cases of Premature Rupture of Membranes

Abstract

Background: Expectant management of Premature Rupture of Membranes (PROM) is a routine in most of the centres usually associated with fetal and maternal complications. Active management by inducing labour will decrease the time between PROM and delivery resulting in lower rates of infections. Objective: To evaluate the clinical effectiveness and safety of the available means of labour induction in cases of pre-labour-rupture of membranes using combination of Misoprostol and intracervical Foley’s or Misoprostol alone. Methods: A Quasi-experimental study, performed in a teaching hospital affiliated with King Edward Medical University Lahore. Women more than 34 weeks of gestation with PROM, singleton, viable foetus with cephalic presentation and no previous caesarean section. After initial evaluation, Subjects included in the study were assessed for Bishop score and those with unfavourable cervix were induced labour with endocervical catheter plus 50 micro grams of intravaginal Misoprostol. The ones with favourable cervix, 50 mcg of Misoprostol was given by oral route. After expulsion of the catheter and in the 2nd group, further augmentation was continued with repeated 4 hourly dose of oral Misoprostol (50 mcg) till the labour was established and after that if required, intra venous Oxytocin infusion was given. Induction to delivery interval, maternal infections like chorioamnionitis, complications noticed during the process like tachysystole and fetal outcome. Aim was to achieve vaginal deliveries within 24 hours and number of C-sections. Results: A study on 113 patients. Out of these 113, vaginal delivery was achieved in 92.9%. Patients were divided into cervical catheter group (n=46) and Misoprostol group (n=67). Vaginal delivery was achieved in 41(89.1%) in the cervical catheter group and 64 (95.5%) in the Misoprostol only group. Out of the total, 8(7.1%) patients had caesarean sections due to fetal distress and failed progress. There were only minor adverse effects and no case of chorioamnionitis recorded. Fetal outcome was satisfactory. Conclusion: Induction of labour in cases of PROM is a better option. Oral Misoprostol in a lower dose or transcervical Catheter combined with intravaginal Misoprostol in poor Bishop score, followed by sequential use of oral Misoprostol is relatively safe and there is a greater probability of vaginal delivery < 24 hours.