Antibiotic Regimen and Induction of Labour Protocol Used in Spontaneous Rupture of Membrane-A Clinical Audit Conducted at a Rural Tertiary Care Hospital In Andhra Pradesh

Abstract

Background: Prelabour rupture of the membranes (PROM) at term or pre-term increases the risk of infection for the woman and her baby. The routine use of antibiotics for women with PROM or PPROM may reduce this risk. However, due to increasing problems with bacterial resistance and it is important to ensure judicious use of antibiotics. Many studies have reported a wide matrix of variation in the management protocol of spontaneous rupture of membrane before the onset of labour at term or pre-term. Hence, we undertook an audit to assess the need for antibiotic prophylaxis and induction of labour in women with PROM or PPROM. Objective: In the paucity of a uniform protocol in the institution, this study aimed to fix a common antibiotic regimen and induction of labour protocol in all cases of PROM and PPROM. Methods: A retrospective and prospective clinical audit was conducted in the department of OBG, PESIMR, Kuppam, for the accrual period of October 2014–October 2015. A retrospective audit for a period of 6 months of the different management protocols of PROM & PPROM cases was carried out to know the prevailing practices of all recruited patients in our hospital across all the three units. Data was collected in a systematic manner using a formatted proforma from the medical records. Following introduction of a uniform protocol, a prospective study was conducted for 6 months. Results: It was noted that in the prospective study the need for antibiotics was reduced to 84.61% as compared to 93.84% in the retrospective group. 69.23% of women required induction in the retrospective group, whereas only 25.64% required induction in the prospective group. The difference was statistically significant. There was not much difference in the caesarean section rates, maternal & neonatal morbidity prior to and following introduction of a uniform protocol (46.15% in the retrospective group to 48.71% in the prospective group). Conclusions: This study helped us introduce a uniform protocol in the department. It reduced the need for induction and antibiotic usage. There was a reduction in the need of induction if expectant management was allowed. There was no reduction in the caesarean section rate. We need more robust studies to come to a conclusion.