Immediate Induction of Labour Versus Expectant Management (Waiting for 24 Hours Before Induction) Forprelabour Rupture of Membranes at Term

Abstract

Background: Prelabour rupture of membrane occur when membrane ruptured without contractions in term
pregnancy.
Objectives: To assess the effects of expectant management versus induction of labour in term prelabour
rupture of membranes on maternal and fetal wellbeing.
Method: This study is carried out in kerbala maternity hospital from October 2018 till December 2019.
(139) patients with rupture of membrane at term in latent phase of first stage of labor. These patient were
divided into 2 groups; first group (62 pregnant) which was expectant management for 24 hours and a second
group (77 pregnant) which was managed by active induction of labour by using either oxytocin infusion or
prostaglandienes depending on Bi-Shop score of the cervix.
Results: 139 pregnant 50 (35.97%) primigravida and 89(64.03%) had at least one previous vaginal delivery.
Term with membrane rupture and no uterine contractions. 77(55.4%) start active management of labor with
either prostaglandins or oxytocin depending on Bi-shop score of the cervix and 66 (44.6%) start conservative
management. Caesarean section was carried out in 24 (17.3%) of the female mostly due to fetal distress
and arrest of cervical dilatation. Vaginal delivery occur in 115 (82.7%) . The active management group
(19.48%)delivered by caesarean section and (80.52%)delivered vaginally. While the group that managed
conservatively (14.52%) delivered by caesarean section and (85.48%) delivered vaginally and the P- value
between both groups are not significant (0.593).Regarding the duration of labour we found that expectant
management had a mean duration of labour of about 8 hours which is shorter than the mean duration of
labour of active management which is 10 hour, but the P-value is statistically not significant (0.440). There
are no maternal complications in the two groups of pregnant female, but there is one intrapartum fetal death
with active management plane but the difference was statistically not significant. (P-value 0.811).
Conclusion: Conservative or active management of labour are effective as a treatment for term prelabour
rupture of membrane, but active management of labour need close monitoring and associate with more
complications.