Abstract

Introduction: Premature rupture of membranes (PROM) is the spontaneous breach of the chorioamnion with the release of amniotic fluid before the onset of labour.

PROM occurs in approximately 10% (Gunn et all) of all pregnancies and 60-80% occur in term pregnancy. About a third of these occur prior to 37 weeks and approximately 81% of patients went into labour within 24 hrs and 90% within 72 hrs. Preterm PROM is rupture of membranes before 37 completed weeks. PROM is often associated with significant maternal and perinatal infections.

Prolonged PROM: A case premature rupture of membranes in which more than 24 hours has passed between the rupture and onset of labour

Aims and Objectives: To compare the safety & efficacy or oral misoprostol with oxytocin infusion in induction of labour in PROM regarding the following:

• Latency period(induction –onset of contractions)
• Induction –delivery interval
• Mode of delivery
• Maternal and perinatal outcome

Methodology: This study was conducted in the Dept of OBG, Guntur Government Hospital, from april 2017 to may 2018.

100 patients with PROM, who were not in labour were enrolled in the study & were randomized to one of the 2 management protocols. All recruited patients were counselled & informed consent was obtained. Patients randomized to misoprostol group were given 50µg orally at four hourly intervals as required for a maximum of 6 doses till they got adequate uterine contractions. Patients randomized to oxytocin group were started with 2mIU/min infusion and increased every 15-20 min by 2mIU until there were 3 uterine contractions each lasting 40-45 seconds in 10 min.

Patients who satisfied the following criteria were recruited into the study.

Singleton uncomplicated pregnancy with cephalic presentation, Spontaneous rupture of membranes, Bishop’s score 0-5, Primi  or multi gravid, Clear liquor per vaginum, No detectable uterine contractions.

Main outcome measures that were studied were:

Induction to delivery interval, Mode of delivery, Maternal complications, Perinatal outcome, Safety and efficacy of misoprostol compared to oxytocin.

Student ‘t’ test & Mann – Whitney test were used for data analysis & P value of<0.05 was considered significant.

Observations and Results: 84% women delivered with 100ug of misoprostol, cost of induction was 10/-. Meconium stained liquor in 2 cases and hyperstimulation was found in one case. Average latency period in misoprostol is 5% vs 7% in oxytocin group. Induction delivery interval is 9.20hrs vs 14.13hrs in oxytocin group. 5 cases from misoprostol group and 6 cases from oxytocin group underwent LSCS (10%vs 12%). No significant difference in the complications of third stage of labour. Maternal outcome like incidence of PPH, caesarean birth, infection, and gastro intestinal side effects and neonatal outcome including APGAR score, infection ,admission into NICU is similar in both the groups. Labour induction with oxytocin infusion for PROM in an unfavourable cervix is associated with longer induction delivery interval. Despite oxytocin resulting longer induction –delivery interval there was no adverse outcome to mother and neonates.

Conclusion: Oral misoprostol is easy to administer than titrated intravenous oxytocin administration. misoprostol offers several advantages such as longer shelf life, stability at room temperature and easy administration. It has the advantage of exact dose preparation. It avoids intravenous infusion and continuous monitoring. it is effective even in cases of poor bishops score. It also relieves patient’s anxiety and easy mobility. It is an acceptable alternative to traditional oxytocin for labour induction and augmentation in PROM.