scholarly journals A comparative study of feto-maternal outcome in expectant management versus active management in pre-labor rupture of membranes at term

2017 ◽  
Vol 7 (1) ◽  
pp. 146
Author(s):  
Savitha T. S. ◽  
Pruthvi S. ◽  
Sudha C. P. ◽  
Vikram S. Nadig
Keyword(s):  
Caesarean Section ◽  
Maternal Morbidity ◽  
Caesarean Section Rate ◽  
Mode Of Delivery ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Neonatal Infection ◽  
Induction Of Labour ◽  
Active Management ◽  
Induction Group

Background: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 weeks of gestation and before the onset of the regular painful uterine contractions, complicates 5-10% of pregnancies, 80% of cases of PROM occur at term. It complicates the pregnancy leading to maternal and fetal complications, immediate risks such as cord prolapse, cord compression and placental abruptions, and later risks such as maternal or neonatal infection and the interventions such as caesarean section and instrumental vaginal delivery. These cases are either managed conservatively or by immediate induction of labour. Objective of present study is to compare the efficacy and safety of induction of labor versus expectant management at term PROM, in terms of maternal and fetal outcome.Methods: A randomized control trial of 100 women coming to KIMSH from 01 /04 /2015 to 01 /05 /2016 with PROM at term with duration of leak ≤6 hours and a Bishop score ≤5 were assigned to group A immediate induction group and group B expectant management group with 50 cases in each group.Results: The mean interval from PROM to delivery was significantly shorter in the induction Group 15.62±4.97 as compared with expectant group 17.58±4.78. Incidence of maternal morbidity and neonatal morbidity was comparable in both the groups. Intrapartum complications and mode of delivery were similar in both groups.Conclusions: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval and hospital stay. Maternal morbidity and neonatal morbidity was comparable in both groups. It is concluded that immediate induction is better than expectant management. With active management many patients delivered vaginally within 24 hours without increase in the Caesarean section rate and decreased the need for oxytocin augmentation.

scholarly journals INDUCTION OF LABOUR;

2017 ◽  
Vol 24 (04) ◽  
pp. 522-525
Author(s):  
Nadia Taj ◽  
Rahat Akhtar ◽  
Sumera Mehnaz ◽  
Aamir Furqan
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Expectant Management ◽  
Induction Of Labour ◽  
P Value ◽  
Pregnancy Induced Hypertension ◽  
Induction Group ◽  
Induced Hypertension ◽  
Group A ◽  
Group B

Objectives: To compare maternal outcome in planned induction of laborversus expectant management in pregnancy induced hypertension between 36 to 40 weeks ofgestation. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynecology UnitII of Nishter Hospital Multan. Period: January 2016 to July 2016. Materials and Methods: Onehundred and thirty six (136) women with diagnosis of mild pregnancy induced hypertension,having gestational age 36 to 40 weeks were selected for this study. The selected patients wereallocated randomly into two equal groups i.e. Group A (Induction group) & Group B (Expectantgroup). The primary outcomes of this study were rate of cesarean section delivery anddevelopment of severe pre-eclampsia. Independent sample t-test was used to compare agebetween the groups. Chi-square test was used to compare age groups and study endpointsbetween the groups. Results: Mean gestational age at the time of delivery was 38.3 ± 0.75weeks for group A and 39.2 ± 0.55 weeks for group B (P-value >0.05). Mode of delivery was 52(76.47%) patients by vaginal and 16 (23.53%) by caesarean section in group A. While in groupB, out of 68 deliveries, 40 (58.82%) patients delivered by vaginal and 28 (41.18%) by caesareansection (p-value <0.05). Regarding maternal outcomes, severe pre-eclampsia occurred in 05(7.35%) women of group A while in group B, it was noted 15 (22.05%) women (p-value<0.05).The final outcome was considered satisfactory in 76.47% patients in Induction group regardingvaginal delivery and severe pre-eclampsia while in Expectant group satisfactory outcomes wereachieved in only 23.53% women (p-value <0.05). Conclusion: Induction of labour is associatedwith improved maternal outcome in terms of caesarean section and pre-eclampsia in womenwith mild PIH beyond 36 weeks of gestation as compared to the expectant management.

scholarly journals Two-year comparative study on immediate versus delayed induction in term premature rupture of membranes

2017 ◽  
Vol 7 (1) ◽  
pp. 94
Author(s):  
John Mary Betty Agnes ◽  
Sowmyanarayanan Lavanya
Keyword(s):  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Induction Of Labour ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Maternal Complications ◽  
Safe Delivery ◽  
Pg E2

Background: Premature rupture of membranes (PROM) has an incidence of about 10% of all pregnancies and is a significant event as it can cause maternal complications, neonatal morbidity and mortality. Some believe that the expectant management of PROM at term does not increase the perinatal and maternal morbidity, and immediate induction of labour leads to an increased caesarean section rate. There are some authors who report a significant increase in the rates of neonatal, maternal infection and foetal distress if delivery occurs over 24 hours after PROM. Thus, a data is required to manage the cases of PROM to effect safe delivery for both mother and baby. The objective of the study was to compare the neonatal and maternal outcomes between immediate and delayed induction with PG E2 gel in term PROM.Methods: A hospital based study in women admitted to Obstetrics and Gynaecology Department at R.S.R.M Hospital with a sample of 400 patients in age group between 19- 35 years with gestational age between 37 and 41 weeks were selected for the study. All the 400 cases who presented with term PROM were admitted in labour room and history was elicited regarding age, menstrual and obstetric history with enquiry regarding the time of rupture of membranes, duration and amount of leaking with general, systemic and detailed obstetric examination.Results: The number of PG E2 gel needed for induction varied between the two groups. Around 45 patients in group 2 needed second dose of gel whereas only 32 patients required the second dose in the late induction group and 72 cases got into active labour. There was no difference in maternal and neonatal infectious morbidity between the two groups. This may be due to the use of prophylactic antibiotics. Neonatal outcome was equally good in both the groups.Conclusions: Delayed induction of labour in PROM after a waiting period of 12 hours stands as a reasonable option as it reduces the number of operative deliveries without compromising the maternal and neonatal outcome.

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

scholarly journals Bayesian Scepsis About SWEPIS: Quantifying the Evidence That Early Induction of Labour Prevents Perinatal Deaths

2020 ◽  
Author(s):  
Eric-Jan Wagenmakers ◽  
Alexander Ly
Keyword(s):  
Clinical Trial ◽  
Bayesian Analysis ◽  
Randomized Clinical Trial ◽  
Clinical Studies ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Perinatal Deaths ◽  
Management Group ◽  
Induction Group

In a recent randomized clinical trial, Wennerholm and colleagues compared induction of labour at 41 weeks with expectant management and induction at 42 weeks. The trial was stopped early, because six perinatal deaths occurred in the expectant management group, whereas none occurred in the induction group. Our Bayesian reanalysis finds that the SWEPIS data indeed support the hypothesis that induction of labour at 41 weeks of pregnancy is associated with a lower rate of stillbirths. However, the degree of this support is moderate at best, and arguably provides insufficient ground for terminating the study. In general, it seems hazardous to terminate clinical studies on the basis of a single P&lt;0.05 result, without converging support of a Bayesian analysis.

Prolonged pregnancy

2020 ◽  
pp. 389-394
Author(s):  
Kate F. Walker ◽  
Jim G. Thornton
Keyword(s):  
Caesarean Section ◽  
Pregnancy Loss ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Increased Risk ◽  
Oxytocin Infusion ◽  
Prolonged Pregnancy ◽  
Overall Risk

Prolongation of gestation beyond 42+0 weeks (or 294 days) affects about 6% of pregnancies. It is associated with an increased risk of perinatal morbidity and mortality; the overall risk of pregnancy loss (stillbirth plus death occurring up to the age of 1 year) increases eightfold between 37 weeks and 43 weeks. Since trials comparing induction of labour with expectant management suggest that induction does not increase the rate of caesarean section, many clinicians offer it for pregnancies beyond 41 weeks. Induction of labour is usually performed using prostaglandin ripening followed, if necessary, by amniotomy and oxytocin infusion.

scholarly journals Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

2019 ◽  
Vol 31 (1) ◽  
pp. 23-26
Author(s):  
Mahe Jabeen ◽  
Sabiha Shimul ◽  
Ummay Salma ◽  
Jebunnesa
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Neonatal Outcome ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Cost Of Care ◽  
Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

scholarly journals Hazards and benefits of elective induction of labor at term

2020 ◽  
Vol 9 (9) ◽  
pp. 3626
Author(s):  
Perveena Fareed ◽  
Suzaira Bashir ◽  
Sameer Ahmed Lone
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Induction Of Labor ◽  
Control Group ◽  
Group 4 ◽  
Induction Group ◽  
Group Rate ◽  
Elective Induction ◽  
Nicu Admission ◽  
Spontaneous Onset

Background: The objective of this study was to compare the rates of caesarean section and neonatal outcome in patients with elective induction of labor compared to patients with spontaneous onset of labor.Methods: Authors studied 200 patients with 100 in elective induction group and 100 in spontaneous onset laboring group. Two groups were compared with respect to demographic profile, basic examination, ultrasound findings, P/A, P/V findings, duration of labor, mode of delivery and neonatal outcome.Results: Various parameters like age residence, per abdominal findings were comparable in two groups. Labor was not prolonged in study group compared to control group. Rate of caesarean section remained high in induction group (21%) in comparison to spontaneous laboring group (4%). Rate of instrumental deliveries did not differ significantly between the groups. 5 min Apgar score did not vary significantly; however, the NICU admission was higher in induction group compared to spontaneous laboring group. Duration of hospital stay was longer in study group.Conclusions: Elective induction of labor has higher rates of caesarean deliveries. NICU admission was also longer in induction group.

Sign in / Sign up

Export Citation Format

Share Document