Abstract
Objective: To compare the outcome of induction of labour with titrated dose of oxytocin with or without pre induction cervical ripening using prostaglandin E2.
 Methods: This is a prospective study. Sixty women with prelabour rupture of membranes (PROM) and Bishops score of less than six were randomly assigned to either immediate induction with intravenous oxytocin drip or induction with intravenous oxytocin drip preceded by cervical priming with prostaglandin E2 (PGE2) gel 0.5mg instilled intracervically. These two groups were compared regarding the mode of delivery, induction to delivery interval and maternal and neonatal morbidities.
 Results: Cervical priming with PGE2 resulted in lesser number of caesarean section (5 Vs. 12) and lower incidence of meconium stained liquor (n=6 Vs. n=2). Induction to vaginal delivery interval was shorter when cervical priming was done (5.4 hrs Vs 7.9 hrs). The maternal morbidity was negligible (<1%) in both the groups. The number of neonates with birth asphyxia (n=2) and the need for their resuscitation (n=2) was more in the oxytocin group but the need of antibiotics for the neonates was more in PGE2 group (5% Vs. 3%).
 Conclusion: Induction of labor with oxytocin, with or without cervical priming with vaginal PGE2 gel, are both reasonable options in cases of PROM, since they result in statistically non significant rates of maternal and neonatal morbidities and caesarean section. Cervical priming with prostaglandin results in higher rate of vaginal delivery and shorter induction to vaginal delivery interval and this is viewed as an advantage to the mother.
Highlights
Rupture of membranes before the onset of labour is termed as prelabour rupture of membranes (PROM) and the incidence is reported to be 8% to 10% of all pregnancy.[1,2,3] It is defined as rupture of membranes at least one hour prior to the onset of labor.[4]
Prolonged PROM is defined as an a - Lecturer, Department of Obstetrics and Gynaecology, Lumbini Medical College Teaching Hospital, Palpa, Nepal b - Professor, Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
Induction following good cervical ripening seems to reduce caesarean section which is shown by Gungorduk et al where a single dose of sustained release dinoprostone pessary was used before oxytocin infusion and by Chaudhury S. et al where vaginal delivery rate was higher when prostaglandin was used.[12,13]
Summary
Rupture of membranes before the onset of labour is termed as prelabour rupture of membranes (PROM) and the incidence is reported to be 8% to 10% of all pregnancy.[1,2,3] It is defined as rupture of membranes at least one hour prior to the onset of labor.[4]. Interval greater than 24 hours between PROM and active phase of labour.[5] Fetal membranes serve as a barrier to ascending infection so once rupture of membranes occur, there is increased risk of infection, both to the mother and the fetus.[6] PROM is associated with significant maternal risks mainly chorioamnionitis and the postnatal risks include endometritis and pelvic infection.[7] Intrapartum risk factor relate to obstetric interventions mainly induction, which when done with unfavorable cervix often leads to prolonged labour and higher risk of operative delivery. The main fetal problem is related to infection along with risk of fetal hypoxia as a consequence of cord compression, cord prolapse and placental abruption.[6]
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