Induced labor outcome with or without cervical ripening in term premature rupture of membranes in ethiopia

Background: Premature rupture of membranes (PROM), if not followed by natural labor or delivered within a limited period of time, will lead to complications such as the development of infections and a reduced volume of amniotic fluid. These complications will have negative maternal and perinatal health outcomes. Several factors affect the success of labor induction in women with term premature rupture of membranes. Objective: This study compares the pregnancy outcome and success of induction of labor in women with term premature rupture of membranes and low BISHOP score, managed with direct oxytocin induction protocol and prostaglandin followed by oxytocin protocol. Methods: A facility basedcomparative cross-sectional study design was used on cases of term premature rupture of membranes having a low BISHOP score in three teaching hospitals of Addis Abeba University. As both protocols are practiced in these hospitals, mothers managed with direct oxytocin induction protocol were compared with those managed with prostaglandin and oxytocin protocol for induction of labor. Results: Out of the total 98 term premature rupture of membranecases with low BISHOP score included in the study, 49 mothers were managed with the direct oxytocin protocol while the remaining were managed with the prostaglandin and oxytocin protocol. Increased cesarean delivery due to failed labor induction and non-reassuring fetal heart pattern was observed usingthe direct oxytocin protocol group. Conclusion: Prostaglandin cervical ripening reduces the burden of cesarean section in cases of term premature rupture of membranes with low BISHOP score. Addis Ababa University, College of Health Sciences, Department of Obstetrics and Gynecology. *Corresponding author e-mail: siteet@yahoo.com, sisay.teklu1@aau.edu.et INTRODUCTION Premature rupture of membranes (PROM) is defined as rupture of fetal membranes before the onset of labor. It occurs in 8-10% of all pregnancies and most often (80%), it occurs at term(1). PROM at any gestational age is associated with a brieflatency period from membrane rupture to delivery. The latency period increases withdecreasing gestational age at membrane rupture. Women with term PROM who are followed expectantly will go into spontaneous labor and will deliver within 24, 48, and 72 hours of PROM in 70, 85 and 95 percent of cases respectively (2-5). Chorioamnionitis is the most common maternal complication after PROM. Abruptio placentae can cause PROM or can occur subsequent to membrane rupture, and it affects 4% to 12% ofsuchpregnancies. Fetal complications after membrane rupture include infection and non-reassuring fetal heart rate pattern (NRFHRP) due to umbilical cord compression orplacental abruption. If the interval from leaking to delivery exceeds 18 hours, there is an increase in incidence of neonatal infections and admissions (6,7). The recommended management strategy for a woman with PROM at term has changed considerably during the last several decades. Various pharmacological agents have been introduced to stimulate uterine contractions and for cervical ripening but only few have been scientifically evaluated. Intravenous oxytocin, mechanical methods and different preparations of prostaglandins have been used for inducing labor but the effectiveness of these agents varies.Intravenous oxytocin infusion has stood the test of time as a labor inducing agent. The advantages of misoprostol include effectiveness, low cost and ease of administration. The lower the pre-induction BISHOP score, the more time that will be required for the woman to go into active labor irrespective of the drug used (7). The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice recommends that the decision regarding management of term PROM should be direct induction. However for those mothers who decline induction, expectant management can be offered after counseling about the risks.