Fetomaternal Outcome with Active versus Expectant Management of Pre Labour-Rupture of Membranes at Term; A randomized controlled trial

Abstract

Background: Prelabour Rupture of Membranes (PROM) at term complicates 10% of all pregnancies, leading to a number of possible fetomaternal complications. No set management plan has yet been devised whether to deliver such women immediately or to wait for spontaneous labour.

Objective: To compare fetomaternal outcome with immediate/active versus expectant management in pregnancies complicated with pre labour rupture of membranes at term. Methodology: A randomized prospective controlled trial conducted in Obstertics & Gynaecology department of Benazir Bhutto Hospital, Rawalpindi. All women presenting with PROM at term and fulfilling the defined inclusion criteria were recruited and randomized equally to Group-A and Group-B for Active versus Expectant management. The latency period for onset of labour, mode of delivery, maternal and fetal complications were compared in two groups.
Results: During study period, 190 women were recruited. The mean maternal age was 26.16 years. Out of total, 45% were primigravidas, 40% multigravidas and 15% were grand multiparas. There was no statistically significant difference in mode of delivery between two groups (p-value The latency period was significantly prolonged (>24 hours) in 57.9 % of the patients with expectant management (p-value <0.05). The rate of PPH (p-value 0.004) and chorioamnionitis (p-value 0.005) was higher in expectant group and while neonatal complications were comparable in both groups (p-value >0.05).
Conclusion: The active management of PROM is the preferred management option due to a shorter latency period, lesser maternal complications, without any significant increase in the rate of operative delivery.

Key words: Active management, Expectant management, Latency period, Premature rupture of membranes, PROM.