scholarly journals A COMPARATIVE STUDY BETWEEN ACTIVE AND EXPECTANT MANAGEMENT OF PREMATURE RUPTURE OF MEMBRANES AT TERM TO EVALUATE FETOMATERNALAND PERINATAL OUTCOMES

2020 ◽  
pp. 3-4
Author(s):  
Varsha Sharma ◽  
Usha Agarwal ◽  
Richa Choudhary ◽  
Manju Goyal
Keyword(s):  
Comparative Study ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Admission Rate ◽  
Induction Of Labour ◽  
Premature Rupture ◽  
Management Group ◽  
Vaginal Deliveries ◽  
Nicu Admission ◽  
Group B

Premature rupture of the membranes is defined as the spontaneous rupture of the chorioamnion before the onset of uterine contractions, this is also known as Prelabour rupture of membrane. In some Indian studies the incidence of PROM is reported as 7-12% in term pregnancy. This study was conducted at Narayana Multispeciality Hospital, Jaipur, Rajasthan, for 7 months of duration (from February 2020 to August 2020). This study was Prospective, Observational and Comparative study. A total 70 term PROM patients were recruited in our study and divided into two groups randomly- 35 (Group A) patients were managed actively by induction of labour and 35 (Group B) patients underwent expectant management. Both these patient groups were studied to compare the feto-maternal outcome. Patients in Actively managed group were induced with iv oxytocin infusion. In Expectantly management group patients were observed to await the spontaneous onset of labour pains for at least 24 hours. In our study vaginal deliveries in actively managed group are 65.7% and in expectantly managed group its 54% and in 51% cases of actively managed cases PROM to delivery interval was less than 12 hours and in 88% cases of expectantly managed group PROM to delivery interval was 12 to 24 hours. APGAR score was notably higher in expectant management group. Therefore, from our study we concluded that immediate induction of labour in term PROM cases favours vaginal deliveries, shortens the PROM to delivery interval and reduces NICU admission rate.

scholarly journals A COMPARITIVE STUDY ON INDUCTION OF LABOUR VERSUS EXPECTANT MANAGEMENT IN TERM PREMATURE RUPTURE OF MEMBRANES IN TERTIARY CARE HOSPITAL ,VISAKHAPATNAM

2019 ◽  
pp. 1-3
Author(s):  
Kavitha Gayak
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Care Hospital ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Management Group ◽  
Group A ◽  
Group B

Premature rupture of membranes (PROM), also called Prelabour Rupture Of Membranes, is classically dened as rupture of membranes before labour and accounts for 0.8-0.9% of all pregnancies at term. this study was conducted over a period of 14 months ( from March 2018 to May 2019) in a tertiary care medical college . A total of 100 term PROM patients were recruited in our study – and divided into two groups randomly--50 (Group A) patients were managed conservatively and 50 (Group- B) patients underwent induction of labour. Both these patient groups were studied to compare the feto-maternal outcome. Group-A (conservative management group) patients were observed to await the spontaneous onset of labour pains for at least 24 hours. Patients in group B were induced with either - PGE1 tab (misoprostol) 25 µgm 4 hourly orally or iv oxytocin infusion. the PROM-delivery interval was < 12 hours in 72 % of induced groups (Group B) and 10% (5) in group- A (conservative or expectant group). LSCS rate was 10 % in group-A (expectant group) & 15 % in group –B (induced group). Sepsis rate, maternal and fetal, hospital stay, NICU admission & duration of NICU stay were notably higher in group – A (expectant management group). therefore, from our study we concluded that immediate induction of labour in term PROM cases shortens the PROM- delivery interval, hospital stay, NICU stay and reduction in both maternal & neonatal sepsis

COMPARATIVE STUDY OF MATERNALAND NEONATAL OUTCOME OF ELECTIVE INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT AT 40- 40+6 WEEKS OF GESTATION

2021 ◽  
pp. 37-39
Author(s):  
Indrani Mandal ◽  
Bivash Mondal ◽  
Debarshi Jana
Keyword(s):  
Vaginal Delivery ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Instrumental Delivery ◽  
Special Care Unit ◽  
Management Group ◽  
Elective Induction ◽  
Group A ◽  
Group B

OBJECTIVES: To compare and analyse in each group- delivery complications like postpartum haemorrhage, obstetric anal sphincter injury at 40-40+6 Week of Gestation. To compare and analyse in each group- perinatal outcomes, mainly perinatal mortality and special care unit admission. METHODS: This prospective comparative observational study was conducted in the Department of Gynaecology & Obstetrics, R. G. Kar Medical College and Hospital. For my study I had taken a total of 276 mothers whom I had subdivided into 2 groups. Group Ahad 138 mothers who had induction of labour (I) by some method. Remaining 138 mothers were allocated to Group B who had only watchful expectancy with monitoring and labeed as expectant management group(EM). RESULT: In group-A (I), 5(3.6%) patients had instrumental delivery in comparison to group B(EM) which had 15(10.9%) of instrumental delivery. LSCS was also higher in group B i.e 36(26.1%) as compared to group A i.e 25(18.1%). 108(78.3%) mothers had vaginal delivery who were induced whereas 87(63.0%) had vaginal delivery in expectant management group. Therefore, induction group had better outcome in terms of mode of delivery.It was also statistically signicant (p=0.0098). The distribution on the basis of APGAR score at 5 minutes of babies in between two groups was signicant. CONCLUSION: Elective induction at 40+ weeks is associated with a lower rate of caesarean delivery and does not increase the risk of major complications for newborns and can be offered to mothers having low risk and crossed their expected date of delivery.The ACOG says elective induction at 40+ weeks is a reasonable option for healthy women. Induction of labour at 40+ weeks should not be routine for women but it is important to counsel them and let them decide whether they want to be induced and when.

scholarly journals Active Versus Expectant Management for Preterm Premature Rupture of Membranes at 34–36 Weeks of Gestation and the Associated Adverse Perinatal Outcomes

2020 ◽  
Vol 42 (11) ◽  
pp. 717-725
Author(s):  
Malú Flôres Ferraz ◽  
Thaísa De Souza Lima ◽  
Sarah Moura Cintra ◽  
Edward Araujo Júnior ◽  
Caetano Galvão Petrini ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Management Group ◽  
Group I ◽  
Adverse Perinatal Outcomes ◽  
Group Ii

Abstract Objective To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

scholarly journals Maternal Outcomes of Expectant Management In comparison with Induction of Labour within twenty four hours of Premature Rupture of Membranes (PROM).

2020 ◽  
Vol 27 (08) ◽  
pp. 1565-1569
Author(s):  
Saima Ashraf ◽  
Hajira Sultana ◽  
Saima Yasmin Qadir ◽  
Muhammad Khalid
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Maternal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Group A ◽  
Group B

Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m2 and in Group (B) it was 26.361 ±4.33 kg/m2. In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.

scholarly journals A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

2019 ◽  
Vol 8 (5) ◽  
pp. 1889
Author(s):  
Anjuman Alam ◽  
Poonam Choubey
Keyword(s):  
Gestational Hypertension ◽  
Severe Hypertension ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Expectant Management ◽  
Pulmonary Complications ◽  
Induction Of Labour ◽  
Management Group ◽  
Group A ◽  
Group B

Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.

scholarly journals A comparative study of 25µg versus 50µg vaginal misoprostol for induction of labour at term premature rupture of membrane

2017 ◽  
Vol 6 (4) ◽  
pp. 1511
Author(s):  
Renu K. Sinha ◽  
Santoshi Gupta
Keyword(s):  
Comparative Study ◽  
Induction Of Labour ◽  
P Value ◽  
Premature Rupture ◽  
Spontaneous Vaginal Delivery ◽  
Misoprostol Group ◽  
Group A ◽  
Vaginal Misoprostol ◽  
Group B ◽  
Foetal Infection

Background: At term, infection remains the most serious complication associated with PROM for the mother and the neonate Induction of labour significantly reduces the risk of maternal and foetal infection. This randomized comparative study has been done to compare the effectiveness and safety of low and high dosage (25 mcg and 50mcg) regimen of vaginal misoprostol for induction in term PROM patients.Methods: At term, infection remains the most serious complication associated with PROM for the mother and the neonate Induction of labour significantly reduces the risk of maternal and foetal infection. This randomized comparative study has been done to compare the effectiveness and safety of low and high dosage (25 mcg and 50mcg) regimen of vaginal misoprostol for induction in term PROM patients.Results: PROM to delivery interval was significantly shorter with 50mcg vaginal misoprostol as compared to 25 mcg vaginal misoprostol (15.71±3.29 hours vs. 18.23±3.23 hours, (p value = 0.0023) Number of doses required was less with 50mcg vaginal misoprostol group as compared to 25mcg vaginal misoprostol (1.22±0.42 vs. 1.91±0.80, p value <0.05). 83.6% women in group A and 69.09% women in group B underwent spontaneous vaginal delivery within 24 hours. 3.64% women in group A and 7.27% in group B had instrumental delivery. Caesarean section was performed in 12.27% cases in group A and 23.64% cases in group B. The complication rate was comparable.Conclusions: 50mcg vaginal misoprostol is more effective and safe for induction of labour at term PROM as compared to 25 mcg vaginal misoprostol 

scholarly journals Obstetric and perinatal outcomes of expectant management and immediate induction of labour in term premature rupture of membranes: promising outcomes from expectant management cohort

2022 ◽  
Author(s):  
Sunil E. Tambvekar ◽  
Shobha N. Gudi
Keyword(s):  
Caesarean Section Rate ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Fetal Outcome ◽  
P Value ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Chi Square ◽  
Group A ◽  
Group B

Background: Premature rupture of membranes (PROM) is common obstetric entity, the management even at term is controversial and there is no consensus for definite protocol of management. Objective of the present study is to compare the effectiveness, safety of expectant management of 24 hours and immediate induction with PGE2 gel in terms of maternal and fetal outcome in term PROM.Methods: 200 women were randomized to group A expectant management and group B immediate induction, after strict Inclusion and exclusion criteria. In expectant group waiting period was 24 hours. Multiple end points were examined throughout management. Chi square test and independent t tests were performed for statistical analysis. P value<0.05 was considered significant.Results: Demographic parameters of patients, maternal and gestational age were similar in both groups. Primigravidae were more in both groups A and B. Vaginal delivery rate is more in expectant group and Caesarean Section rate is high in immediate induction group. CS rate was 37% and 23% in group A and B respectively; the difference is statistically significant (p value=0.031). ‘ROM to delivery interval’ was more in group A (16.31±8.67 hrs and 13.85±5.46 hrs) (p value=0.0256). Hospital stay was comparatively more in group A (5.40±0.81 days and 4.11±0.86 days) (p value=0.435). Infective morbidity of mother and baby was low in both groups and no difference was seen.Conclusions: An expectant management allows a good number of women to go into labour and deliver vaginally without an increase in CS rate and infectious morbidity for mother and fetus.

scholarly journals Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

2017 ◽  
Vol 6 (7) ◽  
pp. 2836
Author(s):  
Ashima Taneja ◽  
Kamaldeep Arora ◽  
Isha Chopra ◽  
Anju Grewal ◽  
Sushree Samiksha Naik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Epidural Analgesia ◽  
Comparative Study ◽  
Satisfaction Score ◽  
Epidural Group ◽  
Patient Satisfaction Score ◽  
Vaginal Deliveries ◽  
Group A ◽  
Group B

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

scholarly journals Amino acid infusion in oligohydromnios and increase in AFI and impact on perinatal outcome

2019 ◽  
Vol 8 (2) ◽  
pp. 617
Author(s):  
Isha Sunil ◽  
Chejerla Sunitha ◽  
Harkirat Kaur
Keyword(s):  
Amino Acid ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Apgar Scores ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Vaginal Deliveries ◽  
Group A ◽  
One Year ◽  
Group B

Background: Decreased amniotic fluid is related to adverse maternal and perinatal outcomes. The purpose of this study was to evaluate the role of amino acid infusion in patients of oligohydromnios and compare the perinatal outcome in the two groups.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, ASCOMS Hospital, Jammu for a period of one year from October 2017 to September 2018. A total of 50 women with AFI <8 cm were enrolled in the study . They were divided into two groups of 25 each. Group A were given amino acid infusion and Group B were not given any intervention. These were compared for increase in AFI and perinatal outcome.Results: In the present study, the gain in AFI in Group A was 2.32 ± 0.67 and in group B was 1.32 ± 1.03 which was statistically significant. The perinatal outcome was better Group A compared to Group B with decreased incidence of meconium stained liquor, low birth weight, low APGAR scores and NICU admissions and increase in vaginal deliveries as compared to caesarean sections.Conclusions: The present study suggests that parentral transfusion of amino acid in cases of oligohydromnios significantly increases the AFI of the patient and decreases the incidence of caesarean sections, meconium stained liquor, low APGAR scores and NICU admissions.

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.

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