A comparative study on premature rupture of membranes at term: Immediate induction with PGE2 gel vs delayed induction with oxytocin

Background: Premature rupture of membranes is a common occurance in term pregnancies. It is of significant value in maternal journey as it can cause complications, both maternal and neonatal, so early diagnosis and proper management is important. The purpose of our present study is to assess the effectiveness of early induction with PGE2 gel in comparison to delayed induction with oxytocin in pregnant woman with term premature rupture of membranes.Method: A prospective study was conducted at GMERS Medical College and Hospital, Ahmedabad, India. 150 term pregnant patients with premature rupture of membranes fulfilling the inclusion criteria were selected and randomly assigned to receive either early induction with intracervical PGE2 gel or expectant management for 12 hours followed by induction with intravenous oxytocin drip. The two groups were analysed with respect to labour characteristics, mode of delivery and maternal and neonatal morbidity.Result: In our study, 30% women had spontaneous onset of labor during the waiting period of 12 hours and required oxytocin only for augmentation in later first stage of labor. Induction with PGE2 gel immediately after PROM resulted in significantly shorter PROM delivery interval (14 hrs vs 22 hrs) in comparison to expectant management, especially in nulliparous women. However, no significant difference was observed in the mode of delivery (vaginal delivery rate of 85% in immediate induction group and 78.7% in delayed induction group) and infectious morbidity in mother and fetus in both the groups.Conclusion: In multiparous women with PROM at term, both immediate induction with PGE2 gel and expectant management followed by oxytocin induction resulted in similar intrapartum outcomes. But in nulliparous women, immediate induction with PGE2 gel stands as a far better option in comparison to expectant group with respect to PROM delivery interval and cesarean section rate for non progress of labor and induction failure.