Use of Intravenous Dexamethasone for Cervical Ripening and Labor Induction in Term Pregnancies with Pre-labour Rupture of Membranes: Randomized control trial

Abstract

Abstract Background: During the first 36 to 38 weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state. Concurrently, the cervix begins an early stage of remodeling yet maintains structural integrity. Induction of labour is a complex process involving cervical ripening which undergo extensive remodeling and dynamic changes controlled by hormonal, inflammatory changes, and other biological processes. Aim of the Work: to assess the effect of intravenous administration of dexamethasone on the induction delivery interval in term patients with prelabour rupture of membranes undergoing induction of labor. Patients and Methods: This randomized control trial was conducted at department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital (ASUMH) in the period between August 2020 and January 2021. Participants of this study were 80 full term pregnant women with pre-labor rupture of membranes attended the labor ward in El Demerdash Maternity Hospital and scheduled for induction of labor by 8 mg dexamethasone IV before starting induction by PGE1, after 4 hours oxytocin was added by 1 IU/hr with the dose increasing by 1 IU every 30 minutes till optimal contractions were reached which were three uterine contractions in 10 minutes and each lasting for 40-50 seconds. Results: Fetal distress, arrest of delivery and indications of CS delivery were non-significantly less frequent among Dexamethasone group. Induction-active phase and active phase durations were significantly shorter among dexamethasone group than among control group. Second and third stages durations were non-significantly shorter among dexamethasone group than among control group. Total induction-delivery duration was significantly shorter and rate of vaginal delivery was significantly higher among dexamethasone group than among control group. Postpartum hemorrhage (PPH), postpartum endometritis, chorioamnionitis were not reported among the studied groups. No significant difference between Dexamaethasone and Control groups regarding neonatal condition Conclusion: Intravenous administration of dexamethasone in addition to labor induction protocol shortened the induction - active phase and active phase durations. It shortened the total induction-delivery duration and increased the rate of successful vaginal delivery. It has no effect on second and third stages durations with no increase in incidence of intrapartum, postpartum nor neonatal complications.