Evaluation of Fetomaternal Outcome in Expectant and Active Management of Term Prelabour Rupture of Membranes

Abstract

Background: PROM is a complex condition with multifactorial etiology, including factors like multigravida, low socioeconomic status, concomitant infections, late symptom presentation, and a history of preterm PROM. Conventional management strategies include expectant management, waiting for spontaneous labor, and active management, involving induction with oxytocin or prostaglandins. Objectives: This prospective cross- sectional observational study aimed to evaluate fetomaternal outcomes in both expectant and active management of term PROM. Methods: Conducted at the Obstetrics and Gynecology Department of Rangpur Medical College Hospital, the study included 50 pregnant women with a history of PROM, gestational age ≥37 weeks, and spontaneous membrane rupture. Data were collected from March to September 2019 using purposive sampling. Demographic information was recorded, and clinical examinations were performed. Data were processed, analyzed, and compared between active management (Group-A) and expectant management (Group-B). Results: The study population's age ranged from 17 to 35 years, with a majority aged 20-25 years (42.0%). Most patients were from urban areas (52.0%), with 52% belonging to a socioeconomically disadvantaged class. Group-A, which underwent active management, showed a significantly higher rate of delivery within 12 hours (80.0%) compared to Group-B (48%). Both groups had similar induction-to-delivery intervals. Vaginal deliveries were more frequent in Group-A (84% vs. 64%), while Group-B had a higher rate of C-sections due to fetal distress. Group-B experienced more maternal complications, including puerperal sepsis, wound infections, and postpartum hemorrhage. Neonatal outcomes were better in Group-A, with higher Apgar scores at both 1 and 5 minutes. Conclusion: Active management was associated with better outcomes in term PROM cases compared to expectant management. Early antenatal diagnosis and risk factor identification are essential tools.....